Appeals Form For Wrestling (Page 2 of 2) in pdf

Return to North Carolina High School Athletic Association

(919) 240-7398 FAX

**THIS MUST BE COMPLETED AND SUBMITTED TO THE NCHSAA FOR APPROVAL WITHIN

14 DAYS OF THE INITIAL ASSESSMENTS AND BEFORE THE WRESTLER COMPETES.**

This appeal is for: (check one)

____% bodyfat - complete Part I only

____ Minimum weight - complete area Part II

only

Name of Wrestler: ________________________________________________________________________________________

Name of School: _________________________________________________________

Classification:

___________

Part I

– requires physician’s and parents’/custodians’ signatures

Assumption of risk: I understand the established guidelines indicate that the minimum bodyfat % for males is 7% and 12% for

females. However, I feel that it is safe and healthy for the individual named above to participate in wrestling with a lower %

bodyfat than the guidelines allow.

Medical Office Name:

___________________________________________________________________________________

Address: _________________________________________________________________________________________________

Phone #: _________________________________________________________________________________________________

Physician:

__________________________________________________________________________________________

SIGNATURE

Parents/Custodians:

___________________________________________________________________________________

SIGNATURE

Part II

– Indicate which option described on reserve was used: Option # _______

Results of testing: _________________

Actual weight _________

(reminder: actual weight from date of 1st measurements must be used on date of 2nd measurements)

Date 1st measurements were taken: _______Minimum weight at that time: _______

Date 2nd measurements were taken: ______ Minimum weight at that time: _______

**If hydrostatic measuring was used, complete this part:

Name of Facility Used __________________________________________________________

Minimum weight ___________

Head Coach:

___________________________________________________________________________________

SIGNATURE

Skinfold Measurer:

___________________________________________________________________________________

SIGNATURE

Appeals Form For Wrestling Page 2