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Alternate Year Card

Alternate Year Card

This card is used when the physical examination card on file is still current - no more than two years old - and if there are no changes to the student's medical record. If you are submitting a new physical examination card this year, you do not need to fill out this card.

Student Alternate Year Agreement:

I hereby give my permission for the named student below to compete and represent his/her school in sports. I agree to be financially responsible for the safe return of all athletic equipment issued to him/her. I attest to the fact that the student has not been hospitalized or suffered any serious illness or injury since the time of his/her last physical examination.

If the student has been hospitalized or suffered any serious illness or injury for any reason since the date of his/her last physical examination, please do not sign this card. This student must be re-examined and another physical examination card must be obtained and on file at the school.

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Alternate Year Card

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