Ihsaa Medical Release For Wrestlers Below Body Fat Allowance
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2IHSAA MEDICAL RELEASE FOR WRESTLERS BELOW BODY FAT ALLOWANCE
THIS FORM MAY ONLY BE COMPLETED BY MEDICAL PROFESSIONALS WHO ARE PERMITTED BY IOWA LAW TO
PERFORM PRE-PARTICIPATION ATHLETIC PHYSICALS: (Medical Doctor, MD; Doctor of Osteopathic Medicine, DO;
Doctor of Chiropractic, DC; Physician’s Assistant, PA; or Advanced Registered Nurse Practitioner, ARNP)
This is the ONLY form accepted as a “MEDICAL RELEASE FOR WRESTLERS BELOW BODY FAT
ALLOWANCE.” A copy of this completed form must be mailed or faxed to the Iowa High School Athletic
Association, PO Box 10, Boone, IA 50036 (515-432-2961), by the school for whom the wrestler competes,
after the last signature is obtained.
Any wrestler whose body fat percentage at the time of body composition assessment is below 7% for males
and 12% for females must obtain, in writing, a medical clearance stating the wrestler is naturally at this sub-7% or
12% body fat level, if he/she wants to wrestle at their natural weight. This release is valid for only one season and
expires following the State Dual Team Tournament each year. A wrestler always has the option of wrestling at their
weight predicted at 7%/12% body fat.
The sub-7% male, or sub-12% female, who receives this clearance may NOT wrestle at a weight class below
his/her weight at the time of body composition assessment. Example: A wrestler weighing 110 pounds at the time of
body composition assessment with less than 7% body fat may NOT wrestle below the 112-pound weight class.
WRESTLER’S NAME: ______________________________ GRADE:______ SCHOOL: ____________________________
OFFICIAL BODY COMPOSITION ASSESSMENT VERIFICATION - STEP #1
DATE OF OFFICIAL BODY COMPOSITION ASSESSMENT: _________________________________________________
ACTUAL WEIGHT AT OFFICIAL BODY COMPOSITION ASSESSMENT: _______________________ pounds.
PERCENT BODY FAT AT OFFICIAL BODY COMPOSITION ASSESSMENT: _____________ percent.
____________________________________________________________________________________ _____________
Signature of assessor & name of agency conducting the official body composition assessment
DATE
EXAMINING MEDICAL PROFESSIONAL’S EVALUATION INFORMATION - STEP #2
DATE OF MEDICAL PROFESSIONAL’S EVALUATION: ____________ WEIGHT AT MEDICAL EVALUATION: _________
LICENSED MEDICAL PROFESSIONAL’S APPROVAL (See top of form for approved medical personnel)
It is my medical opinion that the above-named wrestler is naturally below 7% (for males)/12% (for females) body fat
and can compete in a safe and healthy manner at a weight class which may be below their weight predicted at
7%/12% body fat, but which is NOT below their actual body weight at the time their OFFICIAL body composition was
assessed.
____________________________________________________________________________ ____________________
LICENSED MEDICAL PROFESSIONAL’S SIGNATURE
DATE
____________________________________________________________
__________________________________
LICENSED MEDICAL PROFESSIONAL’S NAME (typed or printed)
DESIGNATION (MD, DO, DC, PA. ARNP)
ATHLETIC DIRECTOR/PRINCIPAL ACKNOWLEDGMENT
I acknowledge that the above named wrestler is permitted by his/her parent or guardian and the medical professional signing
this form to compete at their natural weight which is below their 7%/12% weight as predicted by body composition
assessment.
___________________________________________________________________________________ ______________
ATHLETIC DIRECTOR’S OR PRINCIPAL’S SIGNATURE
DATE
- OVER PLEASE -
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