The Kentucky High School Sports form is a crucial document that incoming students must complete to participate in athletic activities. This form includes essential medical information and a physical examination requirement, ensuring that students are fit for sports participation. It is important for parents and guardians to be aware of the immunization requirements and the need for their consent regarding medical treatment.
To ensure your child is ready for the upcoming sports season, please fill out the form by clicking the button below.
The Kentucky High School Sports form is a critical document for all incoming students wishing to participate in athletic activities during the 2021-2022 school year. This form encompasses several essential components, including medical information, parental consent, and physical examination requirements. All students must submit a completed physical examination form, as physicals conducted prior to April 2021 are not accepted. Compliance with state regulations mandates that students provide a current certificate of immunization, which must include vaccinations against diseases such as diphtheria, tetanus, and meningitis. The form also outlines specific guidelines for students interested in cheerleading and dance, emphasizing the necessity of submitting health forms before tryouts. Parental permission is required for the administration of over-the-counter medications, as well as for emergency medical treatment. This ensures that students receive the necessary care in case of injury or illness during school hours or athletic events. In addition, the form includes sections for emergency contact information and insurance details, which are vital for ensuring the safety and well-being of student-athletes. Overall, the Kentucky High School Sports form serves as a comprehensive tool for maintaining health standards and ensuring that students are prepared for participation in school sports.
MEDICAL INFORMATION AND PHYSICAL EXAMINATION FORM
FOR INCOMING STUDENTS 2021-2022
ALL INCOMING STUDENTS MUST SUBMIT A PHYSICAL EXAMINATION FORM—
PHYSICALS COMPLETED PRIOR TO APRIL 2021 WILL NOT BE ACCEPTED.
In compliance with KRS 158.035, KRS 214.0, and KAR 2:060
the original certificate of immunization against diphtheria, tetanus, poliomyelitis, measles, rubella, hepatitis A, and meningitis
must be submitted by every student and kept on file by the school.
Student's final admission status is not complete until the physical examination form and the required
certificate of immunization status have been submitted.
Important Information for Incoming Students Planning to Participate in Athletics
In accordance with KHSAA regulations, the student’s medical history and physical must be reported on the KHSAA form which follows.
Students trying out for CHEERLEADING AND DANCE: physical examination must be completed and health forms turned in prior to tryouts in mid-April. If the physical was conducted between April 2020 and March 2021, it will satisfy the KHSAA requirement, but a current physical examination, conducted April-July 2021, is required by July 29, 2021, to meet the school requirement.
PART 1 - STUDENT INFORMATION
Student's Full Legal Name: _____________________________________________________________________________________
LastFirstMiddle2021-2022 Grade
Student’s Home Address: ______________________________________________________________________________________
Number & Street
City
State
Zip Code
Student’s Date of Birth: ______________________________
Student's Social Security #: ________________________________
Primary Physician _________________________________
Office Phone # ___________________________
Family Dentist ____________________________________
PART 2 – PARENTAL PERMISSION TO ADMINISTER OVER-THE-COUNTER MEDICATION/ PARENTAL CONSENT/PERMISSION TO TREAT AUTHORIZATION – 2021-2022
Parent/guardian signatures are required in order for your daughter
to receive any necessary medical treatment or medication (including Tylenol, Advil, etc.).
In the event of an injury or illness during the school day or at a school event or, if applicable, an athletic event or practice session, I give
permission for my daughter,, to receive proper/necessary care from the school nurse, staff member, certified athletic trainer, or coach. In addition, I authorize treating physicians and/or their representatives to release medical information to representatives of the Assumption Administration, Athletic Department, and coaching staff, as applicable.
In the event of an emergency during the school day or at a school event or, if applicable, an athletic event or practice session, I give
permission for my daughter,, to be transported to an appropriate medical facility for treatment. Furthermore, I give permission for the staff at the medical facility to render any and all treatment that is necessary for the well-being of my daughter. In addition, I authorize treating physicians and/or their representatives to release medical information to representatives of the Assumption Administration, Athletic Department, and coaching staff, as applicable.
Signature: _____________________________________________________ Date: __________________________________
New Kentucky Immunization Laws
The following is a summary of the recent changes, effective June 21, 2017, to 902 KAR 2:060:
Immunizations schedules for attending child day care centers, certified family child care homes, other licensed facilities which are for children, preschool programs, and public and private primary and secondary schools, https://www.lrc.ky.gov/kar/902/002/060.htm . This amended Kentucky Administrative Regulation requires all children to have a current immunization certificate on file, contains the required immunizations schedule for attending, and has a process to obtain a religious exemption from the required immunizations.
One new age-specific immunization requirement and one booster dose requirement effective for the school year beginning on or after July 1, 2018:
2-Dose Series of Hep A ( Age: 12 months through 18 years, to be compliant for the series the second Hep A is given six months after the first inject.)
Quadrivalent meningococcal vaccine (MenACWY) booster dose (Age: 16 years)
Homeschooled children are required to submit to current immunization certificate to participate in any public or private school activities (classroom, extra curriculum activity, or sports).
All vaccines administered are printed on the Commonwealth of Kentucky Certificate of Immunization Status now including immunizations not required for school entry.
Out of state immunization certificates may be accepted if they meet the same age – specific requirements as outlined in this regulation.
A Commonwealth Certificate of Immunization Status printed from the Kentucky Immunization Registry (KYIR) does not require a signature
Routine certificate reviews are to occur at enrollment in a day care center, kindergarten, new enrollment at any grade; upon legal name change; and at a school required examination pursuant to 702 KAR 1:160.
A child whose certificate has exceeded the date for the certificate to be valid shall be recommended to visit the child’s medical provider or local health department to receive immunizations required by this administrative regulation. An updated and current certificate shall be provided to the:
Day care center, certified family child care home, or other licensed facility that cares for the children by a parent or guardian within thirty (30) days from when the certificate was found to be invalid.
School by a parent or guardian within fourteen (14) days from when the certificate was found to be invalid.
Physical Education/Athletic Participation Form
Parental and Student Consent and Release For High School Level (grades 9 - 12) participation
KHSAA Form GE04
High School Parental Permission and Consent
Rev.7/20, page 1 of 2
© KHSAA, 20 20
The student and parents/guardian must read this statement carefully and sign where required. By signing this form, all parties agree that they have accurately completed all sections of the form and have read and agree to the terms of this form as detailed. This form must be completed before the student participates (hereinafter including try out for, practice and/or compete) in interscholastic athletics/physical education. This form should be kept in a secure location until the student has exhausted eligibility, graduated from high school and reached the age of 19.
STUDENT/ATHLETE INFORMATION (This part must be completed by the student and family.)
Name (Last, First, Initial)
School Year
Home Address (Street, City, State, Zip):
Gender
Grade
School
Date of Birth:
Birth Place (County, State):
School Attendance History
Varsity Play –
School Name
(Yes/No)?
9
10
11
12
I am planning to participate in the following
NONE
Basketball
Soccer
Softball
Wrestling
Archery
Esports
Other __________
EMERGENCY CONTACT INFORMATION
(check
all you might try to play):
Cross Country
Football
Swimming
Tennis
Bass Fishing
Bowling
Golf
Track and Field
Competitive Cheer
Lacrosse
Volleyball
Dance
Name (please print)
Relation to Student
Emergency Contact Address, including City, State and Zip
Daytime Phone
Cell Phone
FOR ATHLETES: REQUIRED INSURANCE INFORMATION (KHSAA Bylaw 12)
Prior to participation in practice or contests (including trying for a place on a team)
in any sport or sport activity during the limitation of seasons
as defined in Bylaw 23 , all students are required to have medical insurance with coverage limits of at least $25,000. If this coverage is
provided through the school, contact the Principal or Athletic Director regarding any potential claim.
Individual schools and districts may
impose additional requirements for insurance or coverage during additional periods for activities outside of Bylaw 23.
Insurance Carrier
Policy Number / ID Number
Group Number
Plan
FOR ATHLETES: EMERGENCY TREATMENT INFORMATION
The following information is
recorded solely for potential hospitalization and emergency care needs and is not required to be recorded on this
form. However, those failing to provide this information should be aware that this might be required by emergency treatment facilities prior to rendering service, and failure to provide could result in lack of appropriate care.
Social Security Number
Birth Date
FOR ATHLETES: CONSENT INFORMATION TO PARTICIPATE, ACKNOWLEDGMENT OF RISK, ACKNOWLEDGEMENT OF ELIGIBILITY RULES, LIABILITY WAIVER AND CONSENT AND RELEASE
As parent/legal guardian, I agree to allow my child to participate in interscholastic athletics..
The student and parent/legal guardian recognize that participation in interscholastic athletics involves
some inherent risks for potentially severe
injuries, including but not limited to
death, serious neck, head and spinal injuries which may result in complete or partial paralysis, brain damage,
serious injury to internal organs, serious injury to bones, joints, ligaments, muscles, tendons, and other aspects of the muscular skeletal system, and
serious injury or impairment to other aspects of the body, or eects to the general health and well being of the child. Because of these inherent risks, the student and parent/legal guardian recognize the importance of the student obeying the coaches’ instructions regarding playing techniques, training and other team rules . By signing this form, the student and parent/legal guardian acknowledge that the stude nt’s participation is wholly voluntary and to having read and understood this provision.
The student and parent/legal guardian individually and on behalf of the student, hereby irrevocably, and unconditionally release, acquit, and forever discharge the KHSAA and its ocers, agents, attorneys, representatives and employees (collectively, the “Releasees” ) from any and all losses, claims, demands, actions and causes of action, obligations, damages, and costs or expenses of any nature (including a ttorney’s fees) that the student and/or parent/legal guardian incur or sustain to person, property or both, which arise out of, result from, occur during or are otherwise connected with the student’s participation in interscholastic athletics if due to the ordinary ne gligence of the Releasees.
The student and parent/legal guardian acknowledge that they have read and understood the KHSAA Bylaws by distribution under the handbook links at http://khsaa.org/. Please be aware that a student is subject to the one-year period of ineligibility the bylaw commonly referred to as the "Transfer Rule," upon participation in any varsity contest regardless of the amount of participation or lack thereof.
The student and parent/legal guardian agree to abide by the KHSAA Bylaws and Due Process Procedure as now enacted or later amended. The student and parent/legal guardian further acknowledge that they agree to abide by the rulings of the Commissioner, Assistant Commissioner, Hearing Ocer and Board of Control.
The student and parent/legal guardian acknowledge that the student must have medical insurance coverage up to a limit of $25,000 in order to be eligible to participate in interscholastic athletics.
The student and parent/legal guardian, individually and on behalf of this student, give the high school, the KHSAA and their representatives permission to release this student’s demographic information (including motion picture and still photographic images) and participation statistics (including height, weight and year in school, participation history and other performance based statistics) and other informa tion as may be requested, and agree that the student may be photographed or otherwise digitally or electronically cap tured during school-based competition. All of this material may be used without permission or compensation specically related to the KHSAA and its events .
The student and parent/legal guardian consent to this student receiving a physical examination as r equired by the KHSAA.
The student and parent/legal guardian, individually and on behalf of this student, consent to the high school and the KHSAA and their representatives to use and disclose the necessary personally identiable information from the student’s education records including academic, nancial and health care information, to third parties including school representatives, coaches, athletic trainers, medical facilities, m edical stas, KHSAA legal counsel and the media, for the purpose of receiving proper/necessary medical care and complying with the KHSAA bylaws, including making determinations regarding eligibility to participate in interscholastic athletics and any administrative or legal proceedings resulting from participation or attempted participation in interscholastic athletics, without such disclosure constituting a violation of rights under the Family Educational Rights and Privacy Act. The student and parent/legal guardian, individually and on behalf of this student, further release the high school, the KHSAA and their representatives from any and all claims arising out of the use and disclosure of said necessary personally identiable information, and agree to release to the high school, the KHSAA, and their representatives, upon request, the detailed and completed application for nancial aid.
The student and parent/legal guardian, individually and on behalf of the student, hereby acknowledge that they are aware of and will review if desired, the education materials availab le through the KHSAA, the Centers for Disease Control and other agencies regarding education all individuals with respect to nature and risk of concussion and head injury, including the continuance of play after concussion or head inj ury.
The student and parent/legal guardian, individually and on behalf of the student, hereby consent to allow the student to receive medical treatment that may be deemed advisable by the high school, the KHSAA, and their representatives in the event of injury, accident or ill ness while participating in interscholastic athletics, including, but not limited to, transportation of the student to a medical facility.
STUDENT AND PARENT/GUARDIAN ACKNOWLEDGMENT OF RISK, ELIGIBILITY RULES, LIABILITY WAIVER AND
CONSENT AND RELEASE AND
EMERGENCY PERMISSION FORM
Students’ Name (please print)
Student and Parent/Guardian Address including City, State and Zip
Signature of Student
Date
Please list above any health problems/concerns this student may have, including allergies (medications / others) and any medications presently being used
Name of Parent(s)/Guardian(s) who has/have custody of this student (please print)
Emergency Phone Number
Signature of Parent(s)/Guardian(s) who has/have custody of this student
1
Clearance
PREPARTICIPATION PHYSICAL EVALUATION
MEDICAL ELIGIBILITY FORM
Name: _______________________________________________________ Date of birth: _________________________
Medically eligible for all sports/physical education activites without restriction
Medically eligible for all sports/physical education activites without restriction with recommendations for further evaluation or treatment of
__________________________________________________________________________________________________
Medically eligible for certain sports/physical education activites
Not medically eligible pending further evaluation
Not medically eligible for any sports/physical education activites
Recommendations:___________________________________________________________________________________
I have examined the student named on this form and completed the preparticipation physical evaluation. The student/athlete does not
have apparent clinical contraindications to practice and can participate in the sport(s)/activities as outlined on this form. A copy of the physical examination ndings are on record in my oce and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the medical eligibility until the problem is resolved and the potential consequences are completely explained to the athlete (and parents or guardians).
Name of health care professional (print or type): __________________________________________
Date: ____________________________
Address: _________________________________________________________________________
Phone: ___________________________
Signature of health care professional: _____________________________________________________________________, MD, DO, NP, or PA
SHARED EMERGENCY INFORMATION
Allergies: ____________________________________________________________________________________________
Medications: ________________________________________________________________________________________
Other information: ____________________________________________________________________________________
Emergency contacts: ___________________________________________________________________________________
© 2019 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educa- tional purposes with acknowledgment.
3/20/19 4:18 PM
KHSAA Form PPE02
Physical Exam Form
HISTORY FORM
Note: Complete and sign this form (with your parents if younger than 18) before your appointment.
Name: ________________________________________________________________ Date of birth: _____________________________
Date of examination: _______________________________ Sport(s): _____________________________________________________
Sex at birth (F, M): _________________
List past and current medical conditions. _____________________________________________________________________________
_______________________________________________________________________________________________________________
Have you ever had surgery? If yes, list all past surgical procedures. _______________________________________________________
Medicines and supplements: List all current prescriptions, over-the-counter medicines, and supplements (herbal and nutritional).
Do you have any allergies? If yes, please list all your allergies (ie, medicines, pollens, food, stinging insects).
Patient Health Questionnaire Version 4 (PHQ-4)
Over the last 2 weeks, how often have you been bothered by any of the following problems? (Circle response.)
Not at all
Several days
Over half the days
Nearly every day
Feeling nervous, anxious, or on edge
0
2
3
Not being able to stop or control worrying
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
(A sum of ≥ 3 is considered positive on either subscale [questions 1 and 2, or questions 3 and 4] for screening purposes.)
GENERAL QUESTIONS
(Explain “Yes” answers at the end of this form.
Circle questions if you don’t know the answer.)
Yes
No
1.Do you have any concerns that you would like to discuss with your provider?
2.Has a provider ever denied or restricted your participation in sports for any reason?
3.Do you have any ongoing medical issues or recent illness?
HEART HEALTH QUESTIONS ABOUT YOU
4.Have you ever passed out or nearly passed out during or after exercise?
5.Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?
6. or skip beats (irregular beats) during exercise?
7.Has a doctor ever told you that you have any heart problems?
8.Has a doctor ever requested a test for your heart? For example, electrocardiography (ECG) or echocardiography.
(CONTINUED )
9.Do you get light-headed or feel shorter of breath than your friends during exercise?
10.Have you ever had a seizure?
HEART HEALTH QUESTIONS ABOUT YOUR FAMILY
11.Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 35 years (including drowning or unexplained car crash)?
12.Does anyone in your family have a genetic heart problem such as hypertrophic cardiomyopathy (HCM), Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC), long QT syndrome (LQTS), short QT syndrome (SQTS), Brugada syndrome, or catecholaminergic poly- morphic ventricular tachycardia (CPVT)?
13.Has anyone in your family had a pacemaker or
BONE AND JOINT QUESTIONS
Yes No
14.Have you ever had a stress fracture or an injury to a bone, muscle, ligament, joint, or tendon that caused you to miss a practice or game?
15.Do you have a bone, muscle, ligament, or joint injury that bothers you?
MEDICAL QUESTIONS
16. breathing during or after exercise?
17.Are you missing a kidney, an eye, a testicle (males), your spleen, or any other organ?
18.Do you have groin or testicle pain or a painful bulge or hernia in the groin area?
19.Do you have any recurring skin rashes or rashes that come and go, including herpes or methicillin-resistantStaphylococcus aureus (MRSA)?
20.Have you had a concussion or head injury that caused confusion, a prolonged headache, or memory problems?
21.Have you ever had numbness, had tingling, had weakness in your arms or legs, or been unable to move your arms or legs after being hit or falling?
22.Have you ever become ill while exercising in the heat?
23.Do you or does someone in your family have sickle cell trait or disease?
24.Have you ever had or do you have any prob- lems with your eyes or vision?
MEDICAL QUESTIONS ( CONTINUED )
25.Do you worry about your weight?
26.Are you trying to or has anyone recommended that you gain or lose weight?
27.Are you on a special diet or do you avoid certain types of foods or food groups?
28.Have you ever had an eating disorder?
FEMALES ONLY
29. Have you ever had a menstrual period?
30. menstrual period?
31.When was your most recent menstrual period?
32.How many periods have you had in the past 12 months?
Explain “Yes” answers here.
______________________________________________________
I hereby state that, to the best of my knowledge, my answers to the questions on this form are complete and correct.
Signature of student/athlete: ______________________________________________________________________________________________________
Signature of parent or guardian: __________________________________________________________________________________________
Date: ________________________________________________________
PHYSICAL EXAMINATION FORM
KHSAA Form PPE02 Physical Exam Form
Name: _________________________________________________________________ Date of birth: ____________________________
PHYSICIAN/STATUTORILY AUTHORIZED PROVIDER REMINDERS
1.Consider additional questions on more-sensitive issues.
•Do you feel stressed out or under a lot of pressure?
•Do you ever feel sad, hopeless, depressed, or anxious?
•Do you feel safe at your home or residence?
•Have you ever tried cigarettes, e-cigarettes, chewing tobacco, snu, or dip?
•During the past 30 days, did you use chewing tobacco, snu, or dip?
•Do you drink alcohol or use any other drugs?
•Have you ever taken anabolic steroids or used any other performance-enhancing supplement?
•Have you ever taken any supplements to help you gain or lose weight or improve your performance?
•Do you wear a seat belt, use a helmet, and use condoms?
2.Consider reviewing questions on cardiovascular symptoms (Q4–Q13 of History Form).
EXAMINATION
Height:
Weight:
BP:
/
(
)
Pulse:
Vision: R 20/
L 20/
Corrected:
Y
N
MEDICAL
NORMAL
ABNORMAL FINDINGS
Appearance
•Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly, hyperlaxity,
Eyes, ears, nose, and throat
•
Pupils equal
Hearing
Lymph nodes
Heart **
• Murmurs (auscultation standing, auscultation supine, and ± Valsalva maneuver)
Lungs
Abdomen
Skin
Herpes simplex virus (HSV), lesions suggestive of methicillin-resistant Staphylococcus aureus (MRSA), or
tinea corporis
Neurological
MUSCULOSKELETAL
Neck
Back
Shoulder and arm
Elbow and forearm
Hip and thigh
Knee
Leg and ankle
Foot and toes
Functional
•Double-leg squat test, single-leg squat test, and box drop or step drop test
**Consider electrocardiography (ECG), echocardiography, referral to a cardiologist for abnormal cardiac history or examination ndings, or a combi- nation of those.
ASTHMA AUTHORIZATION FORM 2021-2022
If your daughter has asthma, this form must be completed, signed, and returned to the School Office by Thursday, July 29, 2021.
Kentucky House Bill 353 allows students with asthma to have unobstructed access to asthma medications. The key points of this law are as follows: Public and private school students are allowed to possess and use asthma medications provided that:
•The student has written authorization from a parent and her health care provider to self-administer her asthma medications.
•The written authorization is kept on file at school.
•A parent or guardian must sign a statement acknowledging that the school has no liability from any injury sustained by a student from self-administration of medication.
•Permission for self-administration of medications is effective for the current school year and must be renewed each school year.
If you have any questions regarding this law or any asthma issue, please contact the Director of Education & Advocacy, American Lung Association, at 363-2652.
STUDENT NAME: __________________________________________________________
STUDENT I.D. #________________
(PRINT):
Last
First
Middle
(office use only]
If your daughter has asthma, but does NOT need to self-administer asthma medications at school,
complete and sign only this section of the form and return the signed form to the School Office.
I,_______________________ , parent/guardian of the above named student, verify that my daughter has asthma, but does not need to
carry or self-administer any asthma medications at school, at school-sponsored activities or at any time that she is present on Assumption High School's property.
Signature: _______________________________________________
Date:_____________________________
If your daughter has asthma and must self-administer asthma medications at school,
the parent and the student's health care provider must complete and sign all sections below.
You must return the completed form to the School Office before she will be given permission to self-administer her asthma
medications on school property or at any school-sponsored activity.
I,_________________________, parent/guardian of the above named student, authorize Assumption High School to allow the student
to carry with her and self-administer her asthma medications.
Signature: _______________________________________________ Date:_____________________________
I,_________________________, parent/guardian of the above named student acknowledge that Assumption High School shall incur no
liability as a result of any injury sustained by the student from the self-administration of asthma medications. I agree to indemnify, hold harmless, waive and relinquish any and all claims I may have against Assumption High School and its officers, agents, employees, representatives or volunteers.
If your daughter has asthma and she must self-administer asthma medications at school,
THE STUDENT'S PHYSICIAN MUST COMPLETE THIS SECTION AND SIGN WHERE INDICATED.
I, _________________________________________________, verify that ________________________________________________
Physician/Health Care Provider's Name (please print)
Print Student's Name
has asthma and that the student has been instructed in self-administration of the asthma medications listed below:
Name of Asthma Medication
Prescribed
Time(s), circumstances, any specific instructions under
Dosage
which medication must be administered
______________________________________________________________________________________________________________
Signature: ______________________________________________
Physician/Health Care Provider
FOOD ALLERGY AND ANAPHYLAXIS MEDICATION AUTHORIZATION FORM 2021-2022
If your daughter has a severe food allergy or other allergy that could require the administration of emergency rescue medication,
this form must be completed, signed, and returned to the School Office by Thursday, July 29, 2021.
If your daughter has a severe allergy and may need to self-administer anaphylaxis rescue medication
(epinephrine via EpiPen, Twinject, Auvi-Q, etc.) at school,
You must return the completed form to the School Office before she will be given permission to self-administer her anaphylaxis
rescue medication on school property or at any school-sponsored activity.
to carry with her and self-administer her anaphylaxis rescue medication.
Signature:________________________________________ Date:_____________________________
I,_________________________, parent/guardian of the above named student, authorize Assumption High School personnel to
administer anaphylaxis rescue medication to the student in the event the student is unable to self-administer due to the severity of the allergic reaction/anaphylaxis or not having her rescue medication with her.
liability as a result of any injury sustained by the student from the self-administration of anaphylaxis rescue medication or from Assumption High School personnel administering emergency rescue medication to her. I agree to indemnify, hold harmless, waive and relinquish any and all claims I may have against Assumption High School and its officers, agents, employees, representatives or volunteers.
I,_________________________, parent/guardian of the above named student hereby give permission for the health care provider
completing and signing this form (below) to verify this information with Assumption High School and consult with AHS staff regarding this information.
If your daughter has a severe allergy and may need to self-administer anaphylaxis rescue medication at school,
I, _________________________________________________, verify that __________________________________________________
Physician/Health Care Provider's Name (please print) _Print Student's Name
is extremely reactive to the following allergens (specify) _____________________________________________________________,
has been instructed in self-administration of her anaphylaxis rescue medication, and may carry it with her to self-administer if necessary.
In the event of mild symptoms (itchy mouth, runny nose, mild rash, etc.)., the student may self-administer or school personnel may administer
Antihistamine Brand or Generic: _________________________________________________ Dose ________________________________
In the event of severe symptoms (shortness of breath, tightness of throat, dizziness, etc.)., the student may self-administer or school personnel may administer
Filling out the Kentucky High School Sports form is an important step for incoming students who wish to participate in athletics. Completing this form accurately ensures that all necessary medical information and permissions are on file, allowing for a smooth transition into the school sports program.
After you submit the form, the school will review it to ensure all necessary information is provided. Make sure to follow up if you do not receive confirmation of its receipt. This will help you stay on track for participating in your chosen sports activities.
The Kentucky High School Sports form is a required document for incoming students who wish to participate in athletics at the high school level. It includes a medical information section, a physical examination form, and a parental permission section. This form ensures that students are medically cleared to participate in sports and that their immunization records are up to date.
All incoming students who plan to participate in athletics must submit the Kentucky High School Sports form. This includes students trying out for cheerleading, dance, and any other sports. The form must be completed and submitted before the student can officially participate in any athletic activities.
The physical examination must be conducted after April 2021 to be valid for the 2021-2022 school year. If a physical was completed between April 2020 and March 2021, it may satisfy some requirements, but a new physical must be submitted by July 29, 2021, to meet school standards. The physical must be documented on the KHSAA form.
Students must submit a certificate of immunization that includes vaccines against diphtheria, tetanus, poliomyelitis, measles, rubella, hepatitis A, and meningitis. Recent changes also require a second dose of the Hepatitis A vaccine for students aged 12 months to 18 years and a booster dose of the meningococcal vaccine at age 16. Homeschooled children must also provide current immunization certificates to participate in school activities.
If the Kentucky High School Sports form and the required immunization certificate are not submitted by the deadlines, the student's admission status will remain incomplete. Consequently, the student will be ineligible to participate in any athletic activities until all necessary documents are provided.
The parental permission section allows parents or guardians to authorize necessary medical treatment for their child during school hours or at school events. This includes permission for over-the-counter medications and emergency transportation to medical facilities if needed. Parents must sign this section for their child to receive care.
Participation in athletics carries inherent risks, including the potential for severe injuries. These can range from minor injuries to serious conditions such as paralysis or brain damage. The form requires both the student and parent or guardian to acknowledge these risks and agree to follow safety guidelines and instructions provided by coaches.
The information collected on the Kentucky High School Sports form is used to ensure the health and safety of student-athletes. It is shared with school officials, coaches, and medical personnel as necessary to provide appropriate care. Additionally, it helps schools comply with KHSAA regulations and maintain accurate records of student participation.
Incorrect Dates: Failing to ensure that the physical examination is conducted within the required timeframe. Physicals completed prior to April 2021 will not be accepted.
Missing Immunization Certificate: Not submitting the original certificate of immunization against required diseases. This is mandatory for final admission status.
Incomplete Student Information: Leaving out essential details such as the student's full legal name, date of birth, or home address can lead to delays in processing the form.
Parental Signature Issues: Failing to obtain the necessary signatures from a parent or guardian, which is required for medical treatment authorization.
Incorrect Emergency Contact Information: Providing inaccurate or outdated contact information can hinder communication during emergencies.
Insurance Information Errors: Not providing accurate insurance details or neglecting to confirm that the insurance coverage meets the minimum requirement of $25,000.
Ignoring Health History: Omitting important health problems or concerns, including allergies and medications, can affect the student’s safety and care during athletic participation.
When preparing for participation in high school sports in Kentucky, several important documents accompany the Kentucky High School Sports form. Each of these forms plays a vital role in ensuring that students are medically fit and legally permitted to engage in athletic activities. Below is a list of related forms that are commonly required.
Completing and submitting these forms is essential for the safety and well-being of student-athletes. They ensure that schools are informed of any medical conditions, consent to treatment, and compliance with state regulations. Parents and guardians should carefully review each document to facilitate a smooth process for their child's participation in sports.
The Kentucky High School Sports form is similar to the Pre-Participation Physical Evaluation Form used across various states. Both documents require a thorough medical examination of student-athletes before they can participate in sports. They ensure that students are medically fit and highlight any existing health conditions that could affect their ability to play. Like the Kentucky form, this evaluation must be completed by a licensed healthcare professional and is crucial for safeguarding the health of young athletes.
Another document comparable to the Kentucky High School Sports form is the Parental Consent for Medical Treatment form. This form grants permission for medical professionals to provide care to a student in case of an emergency. Just as the Kentucky form requires parental signatures for treatment, this consent form ensures that parents are aware of and authorize medical procedures for their children during school hours or athletic events. Both documents emphasize the importance of parental involvement in medical decisions regarding their children.
The Immunization Record is also similar in purpose to the Kentucky High School Sports form. Both documents require proof of immunization to ensure the safety and health of students in a school environment. The Kentucky form mandates submission of a current immunization certificate, while the Immunization Record serves as official documentation that a student has received the necessary vaccinations. This helps prevent outbreaks of contagious diseases within the school community.
The Emergency Contact Information form shares similarities with the Kentucky High School Sports form by ensuring that schools have immediate access to necessary contacts in case of an emergency. Both forms require detailed information about who should be contacted if a student is injured or becomes ill. This proactive approach helps schools respond quickly to medical situations, enhancing student safety during school activities.
The Health History form is another document that aligns with the Kentucky High School Sports form. Both forms collect vital health information about students, including allergies, pre-existing conditions, and medications. This information is essential for coaches and medical staff to ensure the well-being of student-athletes during practices and competitions. By gathering comprehensive health data, both forms aim to minimize health risks associated with sports participation.
The Student Athlete Contract often resembles the Kentucky High School Sports form in that it outlines the responsibilities and expectations for student-athletes. Both documents require signatures from students and parents, indicating their understanding of the rules and regulations surrounding participation in sports. This ensures that everyone involved is aware of the commitments required for safe and responsible athletic involvement.
The Sports Injury Report form is similar to the Kentucky High School Sports form as it documents any injuries sustained during athletic activities. Both forms play a crucial role in tracking student health and safety. While the Kentucky form ensures that students are medically cleared to participate, the Sports Injury Report helps schools monitor and manage injuries, ensuring that students receive the necessary care and support.
Lastly, the Athletic Insurance Waiver shares characteristics with the Kentucky High School Sports form. Both documents require parents or guardians to acknowledge the risks associated with athletic participation. The Kentucky form includes a liability waiver that releases the school from responsibility for injuries, while the Athletic Insurance Waiver typically requires parents to confirm that their child has adequate insurance coverage for potential injuries. Both documents aim to inform and protect students and their families.
When filling out the Kentucky High School Sports form, it's essential to approach the task with care. Here’s a list of things you should and shouldn't do to ensure a smooth process.
In reality, only physical examinations completed after April 2021 will be accepted for the 2021-2022 school year. This ensures that students are evaluated with up-to-date health information.
All incoming students must submit a current certificate of immunization. This is mandated by Kentucky law to ensure the health and safety of all students.
Parental permission is required for any medical treatment or medication administration. This protects the rights and health of the student.
All students interested in participating in any athletic activities must complete the necessary forms, regardless of their intended level of participation.
Students must have their physical examination completed within the specified time frame. This is crucial for maintaining current health evaluations.
Even homeschooled children must provide a current immunization certificate if they wish to participate in any public or private school activities, including sports.
Returning students must also submit updated forms, especially if there have been changes in their health status or immunization records.
All required forms must be submitted before the start of any athletic participation. Delays may prevent a student from joining the team.
It is the responsibility of the parents and guardians to ensure that all health information is submitted and kept current with the school.
By signing, parents and guardians acknowledge the risks involved in athletic participation and agree to release the school from certain liabilities, emphasizing the importance of informed consent.
Filling out the Kentucky High School Sports form is an essential step for incoming students wishing to participate in athletics. Here are some key takeaways to keep in mind:
Completing this form accurately and submitting it on time will help ensure a smooth transition into the athletic programs. Always keep a copy for your records and stay informed about any updates or changes to the requirements.