MVA On-Campus Physical Registration and Payment Form

Student-Athlete Name*

First NameLast Name

Student-Athlete Grade Level*

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email*

example@example.com

Disclaimer*

My child is a Day Student - I understand that a parent/guardian must be present for the physician to perform their evaluationMy child is a Boarding Student

Please download the EL2 physical form here and fill out the medical history questions on page 1 and page 2. Our sports medicine team and volunteers will fill out the remainder of the document.

A completed EL2 physical will satisfy MVA's enrollment requirement of a physical examination. Keep in mind participation at our sports physical event is optional, as you may elect to complete this with a separate healthcare provider licensed in the USA.

*

I understand that if I have a valid EL 2 physical completed by a healthcare provider licensed in the USA, I am not required to sign my child up for this event.I understand a valid physical is one that is properly completed, signed & dated by all parties. A physical is valid 1 year from the date of the exam.

*

Please note: Once payment is made, we are not able to offer refunds.

My Products

EL2 Physical - Performed by Florida Sports Injury Team Physicians

$30.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.