2026 Sports Physicals Form

2026 Sports Physicals Form

To schedule an appointment, please fill out the information below.
MSHSAA Requirements

All Athletes including all sports, spirit, & marching band need a sports physical every 2 years.
Cost of Physicals

Physicals cost $10 for first student and $5 for remaining student in the same household.
Appointment Details

Dates Available June 9th from 9-11am, July 11th 9-11am, & August 4th 4-6pm.
June 9th Appointment Times- 2 Students per Time Slot
July 14th Appointment Times - 2 Students Per Time Slot
August 14th Appointment Times- 2 Students per Time Slot
Parent/Guardian Contact Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Student(s) Information
Name of Child
Age and Grade of Child
Name of School Child Attends
Name of Additional Child
Age and Grade of Additional Child
Name of School Child Attends
Additional notes about Child(ren):
CONSENT for SERVICE

I authorize the Caldwell County Health Department in collaboration with Cameron Regional Medical Center provider to provide the health physical service as defined by MSHSAA for my child(ren).

I acknowledge that the above services, the potential risks and benefits of the services as well as the risks associated with not participating in the above services have been explained to me and all questions have been answered.

HIPAA NOTICE

My signature on this form acknowledges that a copy of the Caldwell County Health Department Notice of Privacy Practices has been made available to me. I understand that this document provides an explanation of the ways in which my health information may be used or disclosed by the Caldwell County Health Department and of my rights with respect to my health information. I have been provided with the opportunity to discuss concerns I may have regarding the privacy of my health information.

PRIVACY Policy Link

https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fcaldwellcountyhealth.com%2Fwp-content%2Fuploads%2F2023%2F06%2FCALDWELL-COUNTY-HEALTH-DEPARTMENT.docx&wdOrigin=BROWSELINK

For questions about the above statements, please call our office at 816-586-2311.
Signature
Date:
Link to MSHSAA Preparticipation Physical Form

https://www.mshsaa.org/resources/SportsMedicine/MSHSAA-PPE-MH-SSMB.pdf
Should be Empty:

2026 Sports Physicals Form

MSHSAA Requirements

Appointment Details

Parent/Guardian Contact Information

Student(s) Information