ATHLETICS PRE-PARTICIPATION PHYSICAL EXAMINATION 2007-08

Prior to any student participating in practices, inter-school practices, scrimmages, and/or contests, at any PIAA member school, the student is required to complete a physical evaluation. A student completing a Comprehensive Initial Pre-Participation Physical Evaluation ( need not have a re-certification for a period of twelve (12) months, UNLESS the student suffers a serious illness or injury within those twelve (12) months.

Students seeking to participate in practices, inter-school practices, scrimmages, and/or contests through the CIPPE must have the appropriate forms completed as follows: Section 1, 2, 3, and 3-A must be completed by a parent or guardian of the student. Section 4 must be completed by a licensed physician of medicine or osteopathic medicine. These forms must be turned into the Athletic Director, coach of the sport , or the second floor principal’s office before participation is allowed. If you are mailing the completed forms during the summer please send to: Athletic Office  Wissahickon Middle School  500 Houston Road   Ambler , PA 19002. You may also drop the forms at the WMS main office and  please make a copy of the completed in case the forms become lost over the summer.

A re-certification (form section 5 & 6) is required, for each subsequent sports season, if the student:

a) Suffers an illness or injury which renders the student unable to participate in 25% or more of the regular season; and/or

b) Suffers an illness or injury which resulted in absence from school for ten (10) or more days and/or which requires surgery.

                                  ATHLETICS PRE PARTICIPATION FORM