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Homepage ➨ Fill Out a Valid Alabama High School Physical Template
Content Overview

Guide to Writing Alabama High School Physical

Completing the Alabama High School Physical form is an essential step for student-athletes before participating in sports. This process ensures that all necessary health information is accurately recorded, helping to safeguard the well-being of the student. Below are the steps to guide you through filling out the form correctly.

  1. Gather Required Information: Collect personal details such as your name, age, address, school, and grade.
  2. Complete the History Section: Answer all questions related to your medical history. Be honest about any past injuries, surgeries, or ongoing health issues.
  3. Provide Details for "Yes" Answers: If you answer "Yes" to any questions, explain the circumstances in the space provided. Include dates and any relevant details.
  4. Fill Out the Physical Examination Section: This part will be completed by a licensed physician. Ensure they check all necessary health metrics such as height, weight, and heart rate.
  5. Obtain Physician's Clearance: The physician will indicate whether you are cleared for participation in sports. They will also provide recommendations if necessary.
  6. Sign the Form: Both the athlete and a parent or guardian must sign the form to confirm that the information is accurate and that you understand the requirements.
  7. Submit the Form: Turn in the completed form to your school’s athletic department or the appropriate office as specified.

Document Breakdown

Fact Name Fact Description
Governing Body The Alabama High School Athletic Association (AHSAA) oversees the physical evaluation requirements for high school athletics in Alabama.
Eligibility Requirement Students in grades 7 through 12 must have a current physician's statement on file to participate in interscholastic athletics.
Form Usage The AHSAA requires the use of the AHSAA Physicians Certificate (Form 5) for all physical evaluations.
Validity Period A physical examination is valid for one calendar year from the date it was performed.
Medical History The form includes questions about the athlete's medical history, including past injuries and existing health conditions.
Signature Requirement Both the athlete and a parent or guardian must sign the form, affirming the accuracy of the provided information.
Physical Examination Components The physical evaluation includes checks on cardiovascular health, musculoskeletal condition, and other vital signs.
Clearance Categories Physicians can clear athletes for participation, clear them with conditions, or not clear them at all based on their evaluation.

FAQ

What is the purpose of the Alabama High School Physical form?

The Alabama High School Physical form is designed to assess a student's physical health and readiness for participation in interscholastic athletics. It ensures that students are evaluated by a physician to confirm they are fit to engage in sports activities, thereby promoting safety and well-being.

Who needs to complete the physical form?

All students in grades 7 through 12 who wish to participate in interscholastic athletics are required to complete the physical form. This includes students involved in all sports, regardless of the level of competition.

How often does a student need to submit the physical form?

A physical exam is valid for one calendar year from the date of the exam. Therefore, students must submit a new physical form annually to ensure compliance with eligibility requirements.

What information is required on the physical form?

The form requires basic information such as:

  • Name
  • Sex
  • Age
  • Address
  • School
  • Grade

Additionally, it includes a medical history section where students must disclose any past injuries, medical conditions, or surgeries.

What does the physical examination entail?

The physical examination includes assessments of various body systems, such as cardiovascular, musculoskeletal, and respiratory systems. The examining physician will check vital signs, height, weight, and overall physical condition to determine fitness for sports participation.

What happens if a student is not cleared for participation?

If a student is not cleared for participation, the physician will specify the reasons on the form. The student may need to complete further evaluations or rehabilitation before being eligible to participate in sports.

Who can conduct the physical examination?

The physical examination must be performed by a licensed physician, either an M.D. (Doctor of Medicine) or a D.O. (Doctor of Osteopathy). This ensures that the evaluation is conducted by a qualified medical professional.

Is a parent or guardian required to sign the form?

Yes, a parent or guardian must sign the physical form. This signature indicates that they acknowledge the information provided and consent to the student's participation in athletics.

Where should the completed physical form be submitted?

The completed physical form should be submitted to the Superintendent's or Principal's office of the student's school. It must be on file to confirm the student's eligibility for participation in interscholastic athletics.

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Alabama High School Physical Example

ALABAMA HIGH SCHOOL ATHLETIC ASSOCIATION

Revised 2018

Revised 2018

Preparticipation Physical Evaluation Form

 

History

Date_______________________

Name__________________________________________________ Sex ________ Age______ Date of birth _______________

Address ______________________________________________________________________ Phone______________________

School ________________________________________________________Grade __________ Sport ______________________

Explain “Yes” answers below:

 

 

 

 

 

Yes

No

1.

Has a doctor ever restricted/denied your participation in sports?

 

 

 

 

 

2.

Have you ever been hospitalized or spent a night in a hospital?

 

 

 

 

 

 

Have ever had surgery?

 

 

 

 

 

 

 

 

3.

Do you have any ongoing medical conditions (like Diabetes or Asthma)?

 

 

 

 

4.

Are you presently taking any medications or pills (prescription or over‐the‐counter?

 

5.

Do you have any allergies (medicine, pollens, foods, bees or other stinging insects)?

 

6.

Have you ever passed out during or after exercise?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been dizzy during or after exercise?

 

 

 

 

 

 

 

 

Have you ever had chest pain or discomfort in your chest during or after exercise?

 

 

Do you tire more quickly than your friends during exercise?

 

 

 

 

 

 

 

Have you ever had high blood pressure?

 

 

 

 

 

 

 

 

Have you ever been told that you have a heart murmur, high cholesterol, or heart infection?

 

 

Have you ever had racing of your heart or skipped heartbeats?

 

 

 

 

 

 

Has anyone in your family died of heart problems or a sudden death before age 50?

 

 

Does anyone in your family have a heart condition?

 

 

 

 

 

 

 

Has a doctor ever ordered a test on your heart (EKG, echocardiogram)?

 

 

 

 

7.

Do you have any skin problems (itching, rashes, staph, MRSA, acne)?

 

 

 

 

 

8.

Have you ever had a head injury or concussion?

 

 

 

 

 

 

 

 

Have you ever been knocked out or unconscious?

 

 

 

 

 

 

 

 

Have you ever had a seizure?

 

 

 

 

 

 

 

 

 

Have you ever had a stinger, burner, pinched nerve, or loss of feeling or weakness in your arms or legs?

 

9.

Have you ever had heat or muscle cramps?

 

 

 

 

 

 

 

 

Have you ever been dizzy or passed out in the heat?

 

 

 

 

 

 

10. Do you have trouble breathing or do you cough during or after activity?

 

 

 

 

 

Do you take any medications for asthma (for instance, inhalers)?

 

 

 

 

 

11. Do you use any special equipment (pads, braces, neck rolls, mouth guard, eye guards, etc.)?

 

12. Have you had any problems with your eyes or vision?

 

 

 

 

 

 

 

Do you wear glasses or contacts or protective eye wear?

 

 

 

 

 

 

13. Have you had any other medical problems (infectious mononucleosis, diabetes, infectious diseases, etc.)?

 

14. Have you had a medical problem or injury since your last evaluation?

 

 

 

 

 

15. Have you ever been told you have sickle cell trait?

 

 

 

 

 

 

 

 

Has anyone in your family had sickle cell disease or sickle cell trait?

 

 

 

 

 

16. Have you ever sprained/strained, dislocated, fractured, broken or had repeated swelling or other

 

 

injuries of any bones or joints?

 

 

 

 

 

 

 

 

 

Head

Back

Shoulder

Forearm

Hand

Hip

Knee

Ankle

 

 

Neck

Chest

Elbow

Wrist

Finger

Thigh

Shin

Foot

 

17.When was your first menstrual period?__________________________________________________________________

When was your last menstrual period?___________________________________________________________________

What was the longest time between your periods last year?________________________________________________

Explain “Yes” answers:

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

I hereby state that, to the best of my knowledge, my answers to the above questions are correct.

Signature of athlete ___________________________________________________________ Date ___________________

Signature of parent/guardian __________________________________________________

FORM 5

DUPLICATE AS NEEDED

Rev. 2018 (The revised 2018 form is the official form accepted by the AHSAA.)

Page 1 of 2

Preparticipation Physical Evaluation Rule 1, Sec. 14 — In order for a student to be eligible for interscholastic athletics, there must be

on file in the Superintendent’s or Principal’s office a current physician’s statement certifying that

__________________________________________ the student has passed a physical exam, and that in the opinion of the examining physician (M.D.

 

 

 

Student's name

or D.O.) the student is fully able to participate in interscholastic athletics (Grade s 7‐12). The

 

 

 

AHSAA Physicians Certificate (Form 5 Rev. 2018) must be used. A physical exam will satisfy the

 

 

 

 

 

Physical Examination

requirement for one calendar year through the end of the month from the date of the exam. For

example, a physical given on May 5, 2019, will satisfy the requirement through May 31, 2020.

 

 

 

 

 

 

 

 

 

 

Height ____________ Weight _____________ BP _____ / _____ Pulse ____________

 

 

 

 

Vision R 20 / ____ L 20 / ____ Corrected: Y N

Revised 2018

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIMITED

 

Normal

 

 

Abnormal Findings

 

 

 

 

 

 

 

 

 

 

 

Cardiovascular

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pulses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lungs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Skin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E.N.T.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE

 

Abdominal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Genitalia (males)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Musculoskeletal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neck

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shoulder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Elbow

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wrist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hand

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Back

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Knee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ankle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Foot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clearance:

A.Cleared

B.Cleared after completing evaluation/rehabilitation for: _______________________________________

C. Not cleared for:

Collision

 

 

 

Contact

 

 

 

Noncontact ____ Strenuous

____ Moderately strenuous

____ Nonstrenuous

Due to: ____________________________________________________________________________________________

Recommendation: _________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Name of physician ________________________________________________________________ Date ____________________

Address ________________________________________________________________________ Phone___________________

.

Signature of physician _____________________________________________________________, M.D. or D.O.

(Form must be signed and dated by the attending physician.)

Rev. 2018 (The revised 2018 form is the official form accepted by the AHSAA.)