Directions for Boone High School Athletic Physicals
READ ALL DIRECTIONS FIRST
. INCOMPLETE FORMS WILL NOT BE
PROCESSED & YOU WILL NOT BE ALLOWED TO PARTICIPATE IN ANY
PRACTICES OR GAMES.
Return all physical forms personally to the
FAXED PHYSICALS CANNOT AND WILL NOT BE ACCEPTED
1. DO NOT COME TO OUR CLASSROOM DURING CLASS TIME.
2. DO NOT slide your physical packet under the door, put it in our mailbox,
give it to any coach, or turn it in to the office.
3. PHYSICALS NOT TURNED IN PROPERLY WILL NOT BE PROCESSED
& YOU WILL NOT BE ELIGIBLE FOR PRACTICE OR GAMES.
Directions for the physical
1. PAGE 1: Parent & student must sign the bottom of the front page of the
2. PAGE 2: Fill out name, address, phone number, birth date section. Fill out
history questions completely. If you answer any of the questions “yes” please
explain them on page 3.
3. PAGE 3 : Fill out the insurance information completely. If you have no
insurance please print “NO INSURANCE”
4. PAGE 3: Fill out your name on the top of page 4. At the bottom
a. At the bottom the physician must 1) Check “cleared without
limitations”, 2) sign, 3) date, & 4) stamp the form. If there is no stamp
available the physicians name & phone # must be printed on the
bottom of the form
5. EMERGENCY CARDS: There are 2 emergency cards & BOTH MUST BE
FILLED OUT COMPLETELY
6. Consent and Release from Liability Certificate
a. Read page 2 then
b. The student must sign the top of page 1
the student is
c. The parent must
any sport in which
allowed to participate in
d. The parent/guardian must print their name on the bottom of page 1
e. The student must sign & print their name on the bottom of page 1
I have read & followed all directions carefully.
Student name PRINT
This student’s physical was accepted & approved by: