Physical Evaluation Form

AJSA PHYSICAL EVALUATION INSTTRUCTIONS

Each AJSA football and cheer participant must have a completed Pre-Participation Physical Evaluation before participating in AJSA activities.

AJSA provides the required physical evaluation pages from the KSHSAA Pre-Participation Physical Evaluation form. Families should download and use the AJSA-provided Physical Form and Instructions PDF available on this page. Some clinics may be familiar only with the full KSHSAA school packet, which includes additional school-specific pages that are not applicable to AJSA.

For AJSA purposes, only the AJSA-provided physical evaluation pages are required. Vaccination records are not required and should not be uploaded.

Preferred Upload: Page 4 Only

AJSA prefers that parents upload Page 4 only — the completed Medical Eligibility Form.

Page 4 includes the healthcare provider’s clearance section and the parent/guardian consent section. This allows AJSA to confirm medical eligibility while limiting the amount of private medical history retained by the organization.

Parents who prefer to submit the full four-page AJSA-provided PPE packet may do so. However, if submitting more than Page 4, all pages must be combined into one single PDF file before uploading.

Important: The registration system only retains the last file uploaded. Uploading pages separately may result in AJSA receiving only the final page uploaded, making the submission incomplete.

Before the Appointment

Parents/guardians and athletes should complete the following before seeing the healthcare provider:

Complete the History Form on pages 1 and 2.
Complete the parent/student section at the top of Page 4.
Bring all four AJSA-provided PPE pages to the appointment for provider review.

During the Appointment

The healthcare provider should:

Review the History Form on pages 1 and 2.
Complete the Physical Examination Form on page 3.
Complete and sign the Healthcare Provider section on page 4.

Approved Healthcare Providers

The physical evaluation must be completed and signed by one of the following healthcare providers:

MD, DO, DC, PA-C, or APRN

Required on Page 4

Healthcare provider’s printed name
Healthcare provider’s signature
Date of examination
Provider address and phone number
Parent/guardian signature
Parent/guardian date and phone number

When to Upload the Form

Physical forms may only be uploaded through the athlete’s registration after the athlete has been rostered to a team. Team assignments will begin in late July following the registration deadline.

Once your athlete has been rostered, you will receive an email directing you back to the AJSA registration system to complete the document upload.

Physical forms must be uploaded through the athlete’s registration. Forms emailed to AJSA will not be accepted.

Common Reasons Forms Are Rejected

AJSA will reject physical forms that are:

Incomplete
Missing the healthcare provider signature
Missing the parent/guardian signature
Illegible
Submitted using an unofficial or incorrect version of the form
Emailed instead of uploaded through the registration system
Submitted with vaccination records or unrelated medical documents
Submitted as multiple separate files when more than Page 4 is uploaded. The system only retains the last file uploaded.

AJSA Physical Form & Instructions.pdf

Click the file above to download the AJSA Physical Form & Instructions PDF.