Alternate Year Physical Form

WAUWATOSA SCHOOL DISTRICT                     Sport_____________________

SENIOR HIGH ATHLETIC PARTICIPATION FORM – ALTERNATE YEAR FORM

All students participating in interscholastic athletics must have this sheet on file at the school prior to practice or participation.

PHYSICAL INFORMATION FORM

           _________________________________________________        __________________

Last Name                          First Name               Initial                        Date of Birth

____________________________________          __________       ____     _______

Place of Birth (County and State)                              Grade                 Age       Sex

Family Physician______________________    Family Dentist_______________________

I attest to the fact that the above named student has not had a significant operation, serious illness or injury requiring prolonged treatment since the last pre-participation card.

Signature of Parent                                                                                                           Date                                

NOTE:  If student did not attend a Wauwatosa School last semester, a copy of his/her physical must accompany this form.

THIS SHEET IS TO BE COMPLETED AND RETURNED TO THE ATHLETIC DEPARTMENT