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  • gvhs2022 23physicalexam Parentinfoform

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    This document is a certificate of physical examination for a student athlete at Golden Valley High School. It includes sections to note the student's height, weight, pulse, blood pressure and any normal or abnormal findings for the heart, pulses, lungs, neck, back, shoulders, arms, wrists, hands, hips, thighs, knees, legs, ankles, feet and other areas. The doctor certifies that the student is physically fit to participate in athletics and lists any restrictions.

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    This document is a certificate of physical examination for a student athlete at Golden Valley High School. It includes sections to note the student's height, weight, pulse, blood pressure and any normal or abnormal findings for the heart, pulses, lungs, neck, back, shoulders, arms, wrists, hands, hips, thighs, knees, legs, ankles, feet and other areas. The doctor certifies that the student is physically fit to participate in athletics and lists any restrictions.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    274 views2 pages

    gvhs2022 23physicalexam Parentinfoform

    Uploaded by

    api-628746386
    This document is a certificate of physical examination for a student athlete at Golden Valley High School. It includes sections to note the student's height, weight, pulse, blood pressure and any normal or abnormal findings for the heart, pulses, lungs, neck, back, shoulders, arms, wrists, hands, hips, thighs, knees, legs, ankles, feet and other areas. The doctor certifies that the student is physically fit to participate in athletics and lists any restrictions.

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    © All Rights Reserved
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    of 2

     

    Golden Valley High School 


    CERTIFICATE OF PHYSICAL EXAMINATION 2018/2019 
    2020/2021
    2022/2023
    2019/2020
    NAME __________________________________________ DOB ___/___/_____ 

    HEIGHT __________ WEIGHT __________ PULSE __________ BP _____/_____  Sport___________________

    PLEASE PLACE “X” AS NORMAL OR ABNORMAL FOR ALL FINDINGS BELOW. PLEASE DESCRIBE IN DETAIL ALL 
    ABNORMAL FINDINGS. 
      
    NORMAL  ABNORMAL  COMMENTS 

    HEART          

    PULSES          

    LUNGS          

    NECK          

    BACK          

    SHOULDER/ARM          

    WRIST/HAND          

    HIP/THIGH          

    KNEE          

    LEG/ANKLE/FOOT          

    OTHER PERTINENT INFO          

      
    Additional Comments: 
    ____________________________________________________________________________________________________________
    ____________________________________________________________________________________________________________
    ____________________________________________________________________________________________________________ 
      
    List any restrictions and duration: 
    ____________________________________________________________________________________________________________ 
    ____________________________________________________________________________________________________________ 
      
    I hereby certify that (Student Name) ___________________________________was examined by me 
    on (Date and Year) ________________________ and found to be physically fit to participate in 
    athletics at Golden Valley. 

    _________________________ ___________________ ____________________  ___________ 


    Doctor’s Name (Print)  Doctor’s Signature  Doctor’s Phone Number  Date 
    *****SPORTS PHYSICALS MUST BE COMPLETED BY A MEDICAL DOCTOR******** 
      
    STAMP NAME OR PLACE CARD OF MEDICAL OFFICE BELOW: 

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