Lightweight Health Certificate printable pdf download

Lightweight Health Certificate

This form must be completed by a certified athletic trainer or health professional. All

potential lightweight rowers will need to be certified between Sept. 1, 2015 and April 1,

2016 in order to row as a lightweight in 2016 PSRA regattas. Each form has room for two

athletes. Submit as many forms as necessary.

1) Athlete Name: _______________________________________ Gender: ______

Date of Birth: ________________________ School: _________________________

Date of Test: __________________ Height: ____________ Weight: ____________

Lightweight Eligibility:

FEMALE athletes: Is the athlete safely able to attain and compete at a weight of 130 lbs

and be at or above 12% body fat on April 1, 2016? MALE Athletes: Is the athlete safely

able to attain and compete at a weight of 150 lbs and be at or above 7% body fat on April

1, 2016? Lightweight eligible: YES ______ NO _____

_______________________________________________________________________

2) Athlete Name: _______________________________________ Gender: _______

Date of Birth: ________________________ School: _________________________

Date of Test: __________________ Height: ____________ Weight: ____________

Lightweight Eligibility:

FEMALE athletes: Is the athlete safely able to attain and compete at a weight of 130 lbs

and be at or above 12% body fat on April 1, 2016? MALE Athletes: Is the athlete safely

able to attain and compete at a weight of 150 lbs and be at or above 7% body fat on April

1, 2016? Lightweight eligible: YES ______ NO ______

Athletic Trainer/Health Professional Information:

I certify that the above information is correct.

Name of Professional:___________________________________________________

Licensing Board: _______________________________________________________

Business Phone: _____________________ Business Email:_____________________

Signature: _____________________________________________________________

Lightweight Health Certificate