IMPORTANT DIRECTIONS FOR ATHLETES (GRADES 7-12) AND THEIR PARENT/GUARDIANFOR FILLING OUT THE PHYSICAL FORM:

THE CIPPE

Section 1 – Personal and Emergency Information – to be completed by parent/guardian

Section 2- Certification of Parent/Guardian – Parent/guardian must sign on each sport line in which the student will try out for the school year. Parent/guardian must also read and sign the 4 statements at the bottom of this section.

Section 3- Understanding of Risk of Concussion and Traumatic Brain Injury – to be completed by student and parent/guardian and signed by both the student and the parent/guardian.

Section 4- Understanding of Sudden Cardiac Arrest Symptoms and Warning Signs– to be completed by student and parent/guardian and signed by both the student and the parent/guardian.

Section 5 – Health History – to be completed by student and parent/guardian andsigned by both the student and the parent/guardian.

Section 6 – PIAA Comprehensive Initial Pre-Participation Physical Evaluation and Certification of Authorized Medical Examiner – to be completed, signed and dated by the authorized medical examiner. The physical evaluation will be valid for all sports within the school year.

THIS CANNOT BE DONE PRIOR TO JUNE 1ST!!!

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