NORTH ALLEGHENY SPORTS NETWORK CIPPE Initial Physical Form

CIPPE Pre-participation Physical Information

Initial Physical Process (1^st Sport Played in 2010 – 2011):

(Requires Sections 1, 2, 3, 4 and 8)

• Students must receive a comprehensive pre-participation physical examination on or after June 1, 2010.  Physical exam dates prior to June 1, 2010 will prohibit your child from participating in any interscholastic or club sports. The authorized health examiner must complete Section 4 of the CIPPE Form.  Please be sure that the examiner has signed and dated the bottom of Section 4 and has included your child’s blood pressure and pulse rate.  Students interested in participating in the sport of wrestling must also complete Section 7 no earlier than six weeks prior to the start of the season.  This information is gathered through our Certified Athletic Training Staff.  Dates and times for certifying weight for Section 7 will be listed on the Athletic Page of the North Allegheny website (www.northallegheny.org).
• Please return all required sections of the CIPPE form (Sections 1,2,3,4 and 8) to the Athletic Department, located in the Senior High School, no later than a week prior to the first official practice date of the sports’ season.  Coaches are not authorized to accept any physical forms!  Please be sure to turn it in as soon as possible so there is time to correct any errors before the start of the season.  The forms can be turned into the Athletic Office anytime after June 1, 2010.
• Each team’s head coach will receive a list of student-athletes eligible to participate on the first practice date.  Any delays in turning in the CIPPE form or having an incomplete physical form will result in a loss of tryout time or perhaps losing the opportunity to tryout completely.  It is the responsibility of the student’s parent/guardians to adhere to the provisions of the physical form process.  Athletic personnel will assist you throughout the process.
• If, for whatever reason, you find yourself needing a clinic to conduct the physical exam, there are a number of places who conduct walk-in physicals.  They are:  North Park Urgent Care (next to Outback Steakhouse) at 9401 McKnight Road, Arcadia Center – Pittsburgh 15237 – 412-366-1528;  Med Express Urgent Care – 6998 Crider Road, Mars, PA – 724-778-3627;  or Walgreens – Rt. 228, Mars, PA – 1-888-TAKECARE.
• Complete the IMPACT Concussion test provided by our Certified Athletic Training staff.
• Report to the first practice date at the designated time and location.  First practice times and locations are currently available on the Athletic Page of the North Allegheny website for all fall sports.  It is recommended that, prior to the first practice date, you review these times and locations again because changes may occur at the last minute due to special circumstances.

Recertification for Subsequent Sports (2^nd & 3^rd Sports Played):

(Without an injury – Requires Section 5)

(With an injury – Requires Sections 5 & 6)

• Students participating in more than one sport season in the 2010 – 2011 school year and have not sustained an injury since the initial physical, must complete and turn in Section 5, Recertification form, of the CIPPE Pre-Participation Physical Process.  Recertification for sports must occur for each subsequent sport’s season in the 2010 – 2011 school year.  An additional physical exam (Section 6) is not necessary as long as the student-athlete has not sustained a serious injury or illness since the initial physical was performed.  School administration, its training staff, and our school physician have the right to request a follow up physical. 
• Each recertification form (Section 5) must include updated emergency contact names and phone numbers as well as current health insurance information.
• If a recertification physical (Section 6) is required, you will need to have your authorized health examiner fill out, sign and date Section 6 of the CIPPE physical form.  Any subsequent physical for the purpose of recertification shall come from the initial attending physician.    The North Allegheny Athletic Department does not have any jurisdiction in the fees charged by your authorized medical examiner and will not be responsible for paying such fees if a follow-up physical is necessary.