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