Florida High School Athletic Association Physical Evaluation Form

Submit the completed form to the school's athletic department or designated authority. Ensure all required fields are accurately filled out and signed. For electronic submissions, use the provided email or online portal as per your school's instructions. For physical submissions, deliver the form to the school's office. Always keep a copy of the submitted form for your records. Confirm receipt and acceptance with the school's athletic department.

This form is valid for 365 days from the date of the evaluation. Ensure timely submission for continuous sports eligibility. Check with your school for specific deadlines.

This form is designed to ensure the health and safety of students participating in high school sports. By providing detailed medical history and undergoing a physical examination, students can identify any underlying health conditions that may affect their ability to participate safely in athletic activities. The form also allows physicians to make informed recommendations regarding a student's fitness for sports, helping to prevent potential health risks and ensure optimal performance. Timely completion and submission of this form are essential for maintaining sports eligibility and adhering to school regulations.

• 1. Student's Name: Full name of the student.
• 2. School: Name of the student's school.
• 3. Sex: Gender of the student.
• 4. Age: Current age of the student.
• 5. Date of Birth: Student's date of birth.
• 6. Grade in School: Current grade level of the student.
• 7. Home Address: Residential address of the student.
• 8. Parent/Guardian Name: Name of the student's parent or guardian.
• 9. Emergency Contact: Person to contact in case of emergency.
• 10. Relationship to Student: Relationship of the emergency contact to the student.
• 11. Physician Name: Name of the student's personal or family physician.
• 12. Home Phone: Home phone number.
• 13. Work Phone: Work phone number.
• 14. City/State: City and state of residence.
• 15. Cell Phone: Cell phone number.
• 16. Office Phone: Office phone number.
• 17. Medical History: Details of the student's medical history, including any chronic illnesses, surgeries, allergies, and medications.

Failing to submit this form may result in the student's ineligibility to participate in high school sports. It is crucial to provide accurate and complete information to avoid any delays or issues.

• Ineligibility for Sports: The student will not be allowed to participate in sports activities without a completed form.
• Health Risks: Undisclosed medical conditions may pose a risk to the student's health during physical activities.
• Non-compliance with School Regulations: Failure to submit the form may result in non-compliance with school policies and regulations.

• 1. Prior to Sports Participation: Submit this form before engaging in any sports activities to confirm eligibility.
• 2. Annually: Complete and submit the form every year to maintain continuous sports eligibility.
• 3. After a Medical Condition: Use this form after recovering from a medical condition to reassess fitness for sports.