Accident Insurance Policy
PIAA Physical Form - Revised April 27, 2017
(This is the process for your own doctor physical)
PIAA Sections 1, 2, 3, 4 and 5 to be completed by parent/guardian
PIAA Section 6 to be completed by your own physician
(This is the process for a Pleasant Valley School physical)
PIAA, Sections 1, 2, 3, 4 and 5 to be completed by parent/guardian
Page 1- parent/guardian to sign
Page 2 - PIAA Section 6- Pleasant Valley School Physical
Part I and Part II - bring all forms with you to school physicals
(This is the process for re-certification and/or not injured)
This form is to be completed if you played a prior sport in the
same school year.
Re-Certification by Licensed Physician of Medicine or Osteopathic Medicine.
This form is to be completed if you were seen by athletic trainer.