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1 of 4 PHYSICAL EXAMINATION FORM The physical examination must be performed on or after April 1 by a Physician holding an unlimited license to practice medicine to be valid for the following school year IHSAA By-Law C 3-10 the following school year IHSAA By-Law C 3-10 2 of 4 IHSAA ELIGIBILITY RULES INDIVIDUAL ELIGIBILITY RULES Grades 9 through 12 ATTENTION ATHLETE Your school is a member of the IHSAA and follows established rules. Preparticipation Physical Evaluation HISTORY FORM Note This form is to be lled out by the patient and parent prior to seeing the physician. The physician should keep a copy of this form in the chart. 2010 American Academy of Family Physicians American Academy of Pediatrics American College of Sports Medicine American Society for Sports Medicine American Orthopaedic Society for Sports Medicine and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial educational purposes with acknowledgement. This form has been modi ed by the Indiana High School Athletic Association Inc. IHSAA. Must have had a physical examination between April 1 and your rst practice and led with your principal your completed Consent and Release Certi cate. any person or group. must not accept awards in the form of merchandise meals cash etc. must not participate in an athletic contest during the IHSAA authorized contest season for that sport as an individual or on any team other than your school team. See Rule 15-1a Exception for outstanding student-athlete See Rule 15-1b must not re ect discredit upon your school nor create a disruptive in uence on the discipline good order moral or educational environment in your school. students with remaining eligibility must not participate in tryouts or demonstrations of athletic ability in that sport as a prospective post-secondary school student-athlete. Preparticipation Physical Evaluation HISTORY FORM Note This form is to be lled out by the patient and parent prior to seeing the physician* The physician should keep a copy of this form in the chart. 2010 American Academy of Family Physicians American Academy of Pediatrics American College of Sports Medicine American Society for Sports Medicine American Orthopaedic Society for Sports Medicine and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial educational purposes with acknowledgement. This form has been modi ed by the Indiana High School Athletic Association Inc* IHSAA. To be eligible to represent your school in interschool athletics you must be a regular bona de student in good standing in the school you represent must have enrolled not later than the fteenth day of the current semester. must have completed 10 separate days of organized practice in said sport under the direct supervision of the high school coaching staff preceding date of participation in interschool contests. Excluding Girls Golf SeeRule 101 must have received passing grades at the end of their last grading period in school in at least seventy percent 70 of the maximum number of full credit subjects or the equivalent that a student can take and must be currently enrolled in at least seventy percent 70 of the maximum number of full credit subjects or the equivalent that a student can take.

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