Physical Form

 

Sports Physical Information  ***NEW***

This will be the only form accepted for participation in CHS athletics. Also, please submit the ImPACT consent form as well as this is mandatory to be completed prior to participation,
Dear Crestwood School District Parents, Guardians, and Student Athletes,

 

            Welcome to Crestwood Athletics. Your child’s participation in athletics at Crestwood is an important part of your scholastic career. In order to participate in the many athletic opportunities at Crestwood, a pre-participation physical must be completed prior to any organized activity with the sport that you intend on participating in.

In order to participate in athletics, you will need to have the following completed:

  1. PIAA comprehensive initial pre-participation physical examination (CIPPE)

  2. Proof of current insurance

 

 

The PIAA comprehensive pre-participation physical examination plays a major role in the student athlete’s eligibility for the sport(s) that your student chooses to participate in.

*** The CIPPE must be performed after June 1st, and will expire May 31st of the same school Year ***

 It is also the responsibility of the parent/ guardian to ensure that the CIPPE is completed and signed by the parent/guardian, athlete, and the health care professional that performed the physical in all appropriate locations in the forms.        

All of the pages in the physical that apply to the sport you plan on participating in must be completed.

  1. Personal and Emergency Information

  2. Certification of Parent/ Guardian

  3. Understanding risk of concussion/ Traumatic Brain injury

  4. Understanding Cardiac Arrest symptoms and warning signs

  5. Health History (filled out by parent/ guardian)

  6. PIAA CIPPE (filled out by appropriate health care professional)

  7. Re-certification of Health History (only done when playing for next sport season)

  8. Re-certification of CIPPE (only done when playing for next sport season)

  9. CIPPE for minimum wrestling weight

 

 

 

The PIAA comprehensive initial pre-participation physical examination must be completed by an appropriate medical professional. They include: Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Certified Registered Nurse Practitioner (CRNP), Physician Assistant (PA), or School Nurse Practitioner (SNP).

If you have any questions or concerns, feel free to contact me.

 Sincerely,

 Michael Bannon MS, ATC, LAT, ITAT

Certified Athletic Trainer- Crestwood High School

 Email:  mike.bannon@csdcomets.org  Phone#: 570-474-6782 ext 335    Fax#: 570-474-1175