Dear Priory Parents and Students,
August 3, 2015 will be the first day of practice for all high school students participating in cross-country, football and soccer. Please click here to download the 2015-16 “Pre-Participation Physical Evaluation” form, which the Missouri State High School Activities Association (MSHSAA) requires all students to file with their school office before beginning practice on August 3.
This is a four-page form which the student, parent and physician must complete in order for the student to be cleared to participate. The first page of the form should be filled out and signed by both the student and parent. Please copy the completed first page for your physician to review at the time of the student’s physical exam.
The student’s physician should complete and sign the second page of the form following a physical exam of the student, keeping a copy of the completed first page in the student’s medical file. The third page contains the “Student Agreement” form, which the student should read and sign.
The third and fourth pages contain a “Parent Permission” statement, which includes authorization to participate, authorization for treatment, release of medical information and insurance information. This must be signed by the parent.
The MSHSAA website contains important information on concussion as well as a concussion video. All students and parents must read this information and view the video which can be found on the website under the “Sports Medicine” tab and listed as the “MSHSAA Concussion Information Packet.” Page four of our form requires the signature of both the student and parent acknowledging that these MSHSAA materials on concussion have been reviewed.
Please complete the entire four-page form, including signatures in all appropriate places. High School students should return the completed form to Priory, attn: Mrs. Tina Pilla, by Friday, July 31. Junior School students should return the completed form to Priory, attn: Mrs. Carrie Lane. Keep a copy of the completed form for your own records.
The completed form must be turned in before your high school student will be permitted to participate in the practices for cross-country, football and soccer, which begin on August 3, 2015.
If you have any questions please contact me at (314) 434-3690 ext. 145 or firstname.lastname@example.org.
Director of Athletics