General McLane Athletic Physical/Informational Packet

Student: ________________________________________________ P.I.A.A. Regulations state "The preparticipation physical evaluation for fall sports shall not be performed earlier than June 1. The evaluation or certification for all other sports shall not be performed earlier than six weeks prior to the first legal practice date for each applicable sport.
Last Name   First Name
Sport: ________________________________________________
Specify:
Boys Girls 7/8th 9th JV V
Circle One   Circle One
Coach: ________________________________________________

Dear Parent/Guardian/Athlete:

Welcome to General McLane Athletics. All of the accompanying forms must be correctly
completed before the student participates in practice or competition.

Here is what you need to do--

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1. *P. I. A. A. Parent's Certificate (Not for Cheerleaders)
    Complete top of card (both sides) and sign four (4) times on Parent's
Certificate side (one next to specific sport and three times at
bottom). *(Cheerleaders packet includes General McLane School District Parent Certificate, not P.I.A.A. card).
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2. Health Record and Questionnaire
  Complete Health Record History (signatures are required at the bottom) and complete top line only (Name, Date, Age, DOB) on reverse side.
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 3. Insurance Declaration and Acknowledgement
  Complete entire sheet (Coverage Period--Example--"Jan. 2000 to Jan.2001" or "Continuous" if through your employer). If student resides with natural parents, both parents must sign.
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 4. Medical Treatment Permit
  Complete entirely - signatures at bottom
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 5. Athletic Code of Conduct
  Please detach and keep for your records
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 6. Parent/Coach Relationship
  Please detach and keep for your record.

My signature indicates I have completed all required areas of this packet and have received the
General McLane Athletic Code of Conduct and Parent/Coach Relationship.

  ____________________________________________
  Parent/Guardian Signature