Sports Physicals

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Student-athletes wishing to participate in a PIAA sport/activity must have a sports physical prior to completion. The PIAA requires that students need to receive a sports physical on an annual basis. 

For students who wish to play a sport and have not yet had a sports physical for the current school year, should follow the directions below and complete the physical packet by clicking here

New Physical Directions:
Student-athletes wishing to participate in a Panther Valley sport must receive a Comprehensive Initial Pre-Participation Physical Evaluation (CIPPE) form PRIOR to the start of the sports season. Students who receive a physical this school year, will not need another one to participate in a different sport, unless a serious illness or injury has rendered the student ineligible to participate in the previous sport, for the same school year only. Physicals completed on or before May 31st are valid for the previous school year only. Physicals for the upcoming school year must be completed on or after June 1st of the school calendar year.

  1. Parent/Guardian is to complete AND sign the PINK Personal and Emergency Information form (Section 1).
  2. Parent/Guardian is to complete and sign parts (a), (b), (c), (d), and (e) of the YELLOW Certification of Parent/Guardian form (Section 2).
  3. Parent/Guardian should read and sign the GREEN Understanding the Risk of Concussion form (section 3).
  4. Parent/Guardian should read and sign the WHITE Understanding of Sudden Cardiac Arrest Symptoms and Warning signs form (section 4).
  5. Parent/Guardian must complete the BLUE Health History form (section 5).
  6. Section 6 shall be completed by an advanced practitioner ONLY (CRNP, PA-C, MD/DO). Please do not complete this portion as the parent/guardian.
  7. Parent/Guardian shall complete the WHITE HIPAA/Consent to Treat form for St. Luke’s Sports Medicine. On-site athletic trainers require consent to treat prior to providing care.
    1. Consent to Treat directions (front side):

                                                                     i.      Program – Panther Valley athletics

                                                                   ii.      Please fill-in child’s name/date of birth

                                                                 iii.      Please include limitations/authorizations

    2. HIPAA directions (back side):

                                                               i.      Disclose to – school’s athletic trainer

                                                             ii.      Provide exceptions on who you do not want permission of medical records released to

                                                           iii.      Sign/date at bottom of page 

BEFORE SUBMITTING, PLEASE MAKE SURE ALL SIGNATURES ARE COMPLETE AND DATED BY THE STUDENT-ATHLETE AND THE PARENT/GUARDIAN.

Recertification Directions:

Student-athletes wishing to participate in a Panther Valley sport who have ALREADY received a sport physical for a different sport must complete a Re-Certification by Parent/Guardian form (section 7) only PRIOR to the start of the sports season. Students who receive a physical this school year, will not need another one to participate in a different sport, unless a serious illness or injury has rendered the student ineligible to participate in the previous sport, for the same school year only.

Physicals completed on or before May 31st are valid for the previous school year only. Physicals for the upcoming school year must be completed on or after June 1st of the school calendar year.

If a student-athlete sustained a serious illness or injury that rendered the student ineligible to participate, the student must receive a re-certification by a medical provider (section 7 AND 8). Otherwise, the student will only need to complete section 7. 

  1. Parent/Guardian is to complete AND sign the WHITE Supplemental Health History form (Section 7).
    1. Please fill in all boxes, and note any changes that may have occurred to contact information, insurance, address, and/or medical history.
  2. Parent/Guardian shall complete the WHITE HIPAA/Consent to Treat form for St. Luke’s Sports Medicine. On-site athletic trainers require consent to treat prior to providing care.
    1. Consent to Treat directions (front side):

                                                                     i.      Program – Panther Valley athletics

                                                                   ii.      Please fill-in child’s name/date of birth

                                                                 iii.      Please include limitations/authorizations

    2. HIPAA directions (back side):

                                                                     i.      Disclose to – school’s athletic trainer

                                                                   ii.      Provide exceptions on who you do not want permission of medical records released to

      1. Sign/date at bottom of page 

Student-athletes are encouraged to visit their PCP for a sports physical. Students can also visit a St. Luke's Care Now in Lehighton, Jim Thorpe, or Palmerton, to receive a physical for $25. Please see an athletic trainer for information on additional sports physical locations.


BEFORE SUBMITTING, PLEASE MAKE SURE ALL SIGNATURES ARE COMPLETE AND DATED BY THE STUDENT-ATHLETE AND THE PARENT/GUARDIAN.

All CIPPE forms must be complete and submitted prior to participation in sport. Please submit physical packets to the athletic trainer.