Conestoga High School Athletics: Medical InformationPIAA Forms
- Please note-there has been no revisions to the forms for the Winter (2018-2019) Season. The bottom of the first page should state Revised: March 22, 2017.
Athletes who intend to participate in a sport for the Winter (2018-2019) Season are required to Complete the Following 3 Forms:
All 3 Forms must be completed and submitted to the Athletic Office for review/approval (preferably in person) in order for a student to be eligible to participate. All Forms must be dated after June 1, 2018. You can download the complete (2018-2019) Winter Sports Package here: (2018-2019) Winter Sports Package
- Sections 1-7 of the PIAA Comprehensive Initial Pre-Participation Evaluation. Section 7 is only required if the Physical (Section 6) was certified before the earliest date in which the forms can be collected for the upcoming Winter Season (10/5/18).
- Assumption of Risk, Student Accident, Injury and Guidelines Form*
- Impact Consent Form**(This form must be completed even if a particular sport does not require an actual impact test and/or if a student is not in their scheduled cycle year to be tested for the Baseline Impact Test).
If this is the students 2nd sport in the current school year; the student will need to complete only Section 1 and Section 7 of the PIAA Comprehensive Initial Pre-Participation Evaluation. Section 7 must be dated no earlier than 10/5/18. If any answer on Section 7 is marked off as yes-Section 8 will also be required and must be filled out by the physician. You can download Sections 1 and 7 along with Section 8 here : Section 1 and Section 7 and Section 8.
*All Athletes must submit the Conestoga High School Parent/Guardian Assumption of Riskand Acknowledgement of Guidelines Signature Form. This form must be signed in accordancewith the Rules and Guidelines, School Board Policy and the Concussion and Cardiac Arrestinformation available below.**All students must complete the Impact Consent Form, however, students are tested on a two-year cycle. If a student was tested during the 2017-2018 school year, they do not need a new Impact Baseline Test.
- Winter Sports Forms will be collected starting on Friday, October 5, 2018 through Monday, November 5, 2018 between the hours of 7:00am and 2:30pm in the Athletic Office.
- Winter Sports begin on Friday, November 16th for V/JV Teams and Tuesday, November 27th for Freshman Teams.
PIAA Comprehensive Initial Pre-Participation Physical Evaluation (CIPPE) has several pages that need to be completed:
- Section 1: Personal and Emergency Information sheet.
- Section 2: Certification of Parent/Guardian signed next to the sport the student intends to play, as well as where indicated in parts “B” through “F”
- Section 3: Understanding of Risk of Concussion and Traumatic Brain Injury
- Section 4: Understanding of Sudden Cardiac Arrest Symptoms and Warning Signs
- Section 5: Health History to be completed by parent/guardian
- Section 6: PIAA Comprehensive Initial Pre-Participation Physical Examination and Certification of Authorized Medical Examiner. This should be completed by the student’s physician no earlier than June 1, 2017.
- Section 7: Parent Re-Certification form. By completing this form, the parent or guardian is assuming responsibility that the student’s health is unchanged since he/she was seen by a physician. This form must be completed if the physical has been performed before.
- Section 8: Physician Re-Certification form. This form is only needed if a child has been under a doctor’s care for an injury or illness since their physical.
**NOTE: The misrepresentation of student health information can lead to harmful consequences. Any misrepresentation of a student’s medical status, by either the student or the parent or the guardian, will result in a season’s suspension from interscholastic sports participation.**
If you have any questions, please contact the Athletic Office at (610) 240-1024.**For clearance/medical release from a skin lesion, the following PIAA/NFHS form must be completed in its entirety, and returned to the athletic trainers. Please contact Jess McCloskey or Sarah Chaya if you have any questions. The Skin Lesion Clearance Form is available here.