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Forms- Physical, Concussion, Fees and more

 

KISER

 

There are FIVE sections that need to be MUST be completed prior to participating

 

1. History Form (THIS CAN BE DONE DIGITALLY IN DRAGONFLY MAX or Printed, signed-scanned–& uploaded)

  • a. This form is completed by the student-athlete and his / her parents or guardian.

  • b. Both the athlete and a parent or guardian should sign this form.

 

2. Physical Examination Form

  • a. This section is completed by and signed by a licensed medical professional (MD, DO, NP, or PA-C).

  • b. The physical exam should include a thorough review of the history form. The licensed medical professional should ask any clarifying questions or discuss any areas left blank in the medical history during the physical exam.

  • c. This form should be signed on the date that the physical examination was completed. 

 

3. Medical Eligibility

  • a. This section is completed, SIGNED & STAMPED by the licensed medical professional who reviewed the history form and completed the physical exam. 

  • b. The licensed medical provider should complete the Shared Emergency Information based on findings from the history form and the physical examination. 

  • c. This form should also be signed on the date that the physical examination is completed.

 

4. NCHSAA Gfeller-Waller Student-Athlete & Parent/Legal Custodian Concussion Information Sheet (THIS CAN BE DONE DIGITALLY IN DRAGONFLY MAX or 

Printed, signed-scanned & uploaded

 

5. NCHSAA Eligibility, Consent to Participate and Release Form (THIS CAN BE DONE DIGITALLY IN DRAGONFLY MAX or Printed, signed-scanned–& uploaded

 

Please remember we can always be reached should you have any questions at Kiser Middle School  

 716 Benjamin Parkway, Greensboro, NC 27408P: 336-370-8240 F: 336-370-8248