Athletic Forms

You can complete physicals at the following locations, among others:

https://multco.us/health/student-health-centers

Please download, print and fill out our Athletics Health Physical school sports pre-participation examination .pdf form, linked below.

• PhysicalExamination-2017

Fill out our online athletics medical form below:

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Phone *

Sport(s) *

• Basketball (boys')
• Basketball (girls')
• Soccer (boys')
• Soccer (girls')
• Track & Field
• Volleyball
• Wrestling

Date of Birth *

Parent or Guardian's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Doctor's Name *

First

Last

Doctor's Phone *

Doctors Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Preferred Hospital *

Insurance Company

Insurance Group Number

Insurance ID Number

Emergency Contact Other Than Parent/Guardian: *

First

Last

Does student have any special medical conditions? If yes, please explain. *

Is student taking medication? If yes, please explain. *

Is student allergic to any drugs? If yes, please specify. *

When did student have his/her last tetanus shot? *

Submit