Athletics » 2020-2021 Physical and Pre-Participation Forms

2020-2021 Physical and Pre-Participation Forms

BENJAMIN FRANKLIN MIDDLE SCHOOL

Office of Interscholastic Athletics

219-531-3020

     Participation Packet Instructions

                                   

       Athlete and Parent(s):

 

 The following forms must be completed in full and submitted to the office.    

Participation in conditioning, practices or contests will be denied until all forms are returned completed and with all appropriate parent and athlete signatures and is reviewed and accepted by the Athletic Department.

ALL FORMS ARE LINKED BELOW

 

1. BFMS Athletic Emergency Medical Treatment Wavier:
To be completed and signed by parent; all information requested must be provided.
 
2. IHSAA Pre-Participation Physical Evaluation:

   To be completed and signed by the physician, parents and athletes.

The IHSAA physical form must be completed on or after April 1, 2020.
Only the IHSAA physical form will be accepted.
We will accept IHSAA Physical Form signed by a nurse practitioner.
Please note that page 4 of the physical must be filled out and signed by both of the parents and the student.
Insurance Information, company name and policy number, must be provided.

3. BFMS Acknowledgement and Pledge of the Athletic Code:
To be dated and signed by parent and student athlete. 

4. Disclaimer for Risk of Injury, Health Insurance and Athletic Handbook:

To be dated and signed by parent and student athlete.

 

5. Permission to Photograph/Videotape, Release to Utilize & Release for Newspaper:
To be completed and signed by parent and student athlete.

 

6. Social Media Policy & Guidelines Acknowledgement Form:
To be dated and signed by parent and student athlete.   

 

7. Concussion & Sudden Cardiac Arrest Acknowledgement Form:
To be dated and signed by parent and student athlete.