WV Sports Physical Form

ATTENTION: Completing this form does NOT mean an appointment has been scheduled. While we do accept walk-ins, we strongly recommend making an appointment to ensure your child can be seen within a reasonable amount of time.

If you haven't already, please contact us to schedule an appointment: Call or text 304-643-4005 or visit ihcwv.org/locations to find a campus near you.

Thank you!

We have read the condensed eligibility rules of the WVSSAC athletics. If accepted as a team member, we agree to make every effort to keep up school work and abide by the rules and regulations of the school authorities and the WVSSAC.

Attention Athlete! To be eligible to represent your school in any interscholastic contest, you:

• Must be a regular bona fide student in good standing of the school. (See exception under Rule 127-2-3)
• Must qualify under the Residence and Transfer Rule (127-2-7)
• Must have earned at least 2 units of credit the previous semester. Summer School may be included. (127-2-6)
• Must have attained an overall "C" (2.00) average the previous semester. Summer School may be included. (127-2-6)
• Must not have reached your 15th (MS), 19th (HS) birthday before August 1 of the current school year. (127-2-4)
• Must be residing with parent(s) as specified by Rule 127-2-7 and 8.
  
  1. Unless parents have made a bona fide change of residence during school term.
  2. Unless an AFS or other Foreign-Exchange student (one year of eligibility only).
  3. Unless the residence requirement was met by the 365 calendar days attendance prior to participation.

• If living with legal guardian/custodian, may not participate at the varsity level. (127-2-8)
• Must be an amateur as defined by Rule 127-2-11.
• Must have submitted to your principal before becoming a member of any school athletic team Participation/Parent Consent/Physician Form, completely filled in and properly signed, attesting that you have been examined and found to be physically fit for athletic competition and that your parents consent to your participation. (127-3-3) 
• Must not have transferred from one school to another for athletic purposes. (127-2-7)
• Must not have received, in recognition of your ability as a HS or MS athlete, any award not presented or approved by your school or the
  WVSSAC. (127-3-5)
• Must not, while a member of a school team in any sport, become a member of any other organized team or as an individual participant in
  an unsanctioned meet or tournament in the same sport during the school sport season (See exception 127-2-10).
• Must follow All Star Participation Rule. (127-3-4)
• Must not have been enrolled in more than (8) semesters in grades 9 to 12. Must not have participated in more than three (3) seasons while
  in grades 6-7-8. (Rule 127-2-5).
• Qualify under homeschool rule. (Rule 127-2-3.11, 127-2-7.2k, 126-26-3.1.1 k)

Eligibility to participate in interscholastic athletics is a privilege you earn by meeting not only the above listed minimum standards but also all other standards set by your school and the WVSSAC. If you have any questions regarding your eligibility or are in doubt about the effect any activity or action might have on your eligibility, check with your principal or athletic director. They are aware of the interpretation and intent of each rule. Meeting the intent and spirit of WVSSAC standards will prevent athletes, teams, and schools from being penalized.

MEDICAL DISQUALIFICATION OF THE STUDENT-ATHLETE/ WITHHOLDING A STUDENT-ATHLETE FROM ACTIVITY

The member school's team physician has the final responsibility to determine when a student-athlete is removed or withheld from participation due to an injury, an illness or pregnancy. In addition, clearance for that individual to return to activity is solely the responsibility of the member school's team physician or that physician's designated representative.

I understand that participation may include, when necessary, early dismissal from classes and travel to participate in interscholastic athletic contests. I will not hold the school authorities or West Virginia Secondary School Activities Commission responsible in case of accident or injury as a result of this participation. I also understand that participation in any of those sports listed above may cause permanent disability or death. Please check appropriate space: He/She has student accident insurance available through the school ( ); has football insurance coverage available through the school ( ); is insured to our satisfaction ( ).

I also give my consent and approval for the above named student to receive a physical examination, as required in Part IV, Physician's Certificate, of this form, by an approved health care provider as recommended by the named student's school administration.

I consent to WVSSAC's use of the herein named student's name, likeness, and athletically related information in reports of Inter-School Practices or Scrimmages and Contests, promotional literature of the Association, and other materials and releases related to interscholastic athletics.

I have read/reviewed the concussion and Sudden Cardiac Arrest information as available through the school and at WVSSAC.org. (Click Sports Medicine)

I also give my consent for the physician in attendance and the appropriate medical staff to give treatment at any athletic event for any injury.

After you have reviewed the following information, please select the "Submit" button.