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KSHSAA Pre-Participation Physical Evaluation Form (PPE)

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Prior to the start of the school year, students interested in participating in extra-curricular activities in their school are required to complete a pre-participation physical evaluation to be completed by a healthcare provider.  The annual history and the physical examination shall not be taken earlier than May 1 preceding the school year for which it is applicable.  The KSHSAA recommends completion of this evaluation by athletes/cheerleaders at least one month prior to the first practice to allow time for corrections of deficiencies and implementation of conditioning recommendations.  

The Pre-Participation Physical Evaluation Form has been updated from what has been used in the past.  All students completing physical examinations need to be sure to use the form that has the revision date of 3/2020 in the bottom right hand corner.  Older versions of this form will no longer be accepted.  Since this is a new form, there a few changes that students, parents, and health care providers need to be aware of.  They are outlined below.
 

  • STUDENTS & PARENTS
    • Complete the History Form (pages 1 & 2) PRIOR to your appointment with your healthcare provider.
    • Sign the bottom of your History Form (page 2).
    • Complete the Shared Emergency Information section on the Medical Eligibility Form (page 4).
    • Sign the bottom of the Medical Eligibility Form (page 4) AFTER the pre-participation evaluation is complete and PRIOR to turning the in the PPE to the school.
    • Review the Student Eligibility Checklist (page 5) and SIGN the bottom of the page PRIOR to turning in the completed PPE form to the school.
    • Review and sign the Concussion and Head Injury Release Form provided by the school.
    • NOTE: Two signatures are required by the healthcare provider!
       
  • HEALTHCARE PROVIDERS
    • Review the History Form (pages 1 & 2) with the student and his/her parent/guardian as part of the pre-participation physical evaluation.
    • Complete the Physical Examination Form (page 3) and SIGN the bottom of page 3.
    • Complete the Medical Eligibility Form (page 4) and SIGN page 4.
       

Pre-Participation Physical Evaluation Form (PPE)