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Physicalformwiaa.doc
Handle: Document-6477
Owner: Sundstrom, Sarah (User-3946, 12634:EVERETT)DS
Tuesday, July 12, 2005 08:20:31 AM PDT
Friday, July 2, 2021 10:45:49 AM PDT
Modified By: Diaz, Ailienette (User-392, 08810:EVERETT)DS
Locked By:
  • Everett Public Schools
Pre-participation History and Physical ExaminationA new physical must be completed and on file with the school every 24 months.
  • g.
  • Have you ever had any injuries requiring treatment by a physician? c.
  • Have you ever had a “stinger” or “burner” or “pinched nerve”?
d.
  • Have you ever been “knocked out” or “passed out”?
e.
  • Have you ever had a neck or head injury? b. Have you ever had an ankle injury? ***** ATHLETE SHOULD NOT WRITE BELOW THIS LINE *****
EXAMINER’S COMMENTS ON ALL “YES” ANSWERS (refer to question number): Everett Public SchoolsPre-participation History and...
Allowed
Microsoft Office Word (.doc, .dot) - application/msword
Physicalformwiaa_092407.doc
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