Sections 1 thru 5 – parent/guardian fills out, signs and dates all pages, student is required to sign some pages also.
SECTION 2: CERTIFICATION OF PARENT/GUARDIAN
SECTION 3: UNDERSTANDING OF RISK OF CONCUSSION AND TRAUMATIC BRAIN INJURY
SECTION 4: UNDERSTANDING OF SUDDEN CARDIAC ARREST SYMPTOMS AND WARNING SIGNS
SECTION 5: HEALTH HISTORY
SECTION 6: PIAA COMPREHENSIVE INITIAL PRE-PARTICIPATION PHYSICAL EVALUATION
AND CERTIFICATION OF AUTHORIZED MEDICAL EXAMINER - needs to be filled out by an AME - Authorized Medical Examiner (your child’s doctor). This MUST be dated AFTER 5/31/2014 before they may tryout, practice or play. This is a state law covering all sports.
SECTION 7: RE-CERTIFICATION BY PARENT/GUARDIAN - needs filled out by the parent/guardian only if your child is injured after the PIAA sections 1 thru 6 were turned in.
Section 8: Re-CERTIFICATION BY LICENSED PHYSICIAN OF MEDICINE OR OSTEOPATHIC MEDICINE - needs filled out by an AME (your child’s doctor) if your child is injured after the PIAA sections 1 thru 6 were turned in.
* Section 9: CIPPE MINIMUM WRESTLING WEIGHT - needs to be filled out by the parent/guardian and the AME (your child’s doctor) NO EARLIER THAN six weeks prior to the first Regular Season Contest day of the wrestling season and NO LATER THAN the Monday preceding the first Regular Season Contest day of the wrestling season.
Click on the Link to download the PIAA forms – http://www.neshaminy.org/cms/lib6/PA01000466/Centricity/Domain/433/2013%20sports%20physicals.pdf
Link to the PIAA website - https://www.piaa.org/about/story.aspx