Medical Clearance Examination

Santa Cruz NFL FLAG Football

2014 Medical Clearance Form

ALL PHYSICALS MUST BE DONE APRIL 1 OR LATER.

TO BE COMPLETED, SIGNED AND SUBMITTED TO THE

LOCAL ASSOCIATION BY THE FIRST DAY OF PRACTICE.

THE MEDICAL CLEARANCE MUST BE SIGNED BY YOUR DOCTOR

MEDICAL CLEARANCE EXAMINATION

Child’s Name:

Age:

Weight:

This examination does not constitute a complete medical examination, it does, on this date, based upon my observations, meet the

requirements for the above named child to participate in the following:

Flag Football

Yes

Any known allergies or limitations:

Doctor’s Remarks:

Doctor’s Signature:

Date:

Phone:

If there is any questions please contact your Local Association that you are participating for.

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