Physician and Parental Permission, KHSAA Form GE04, Rev 4 13 - fcps: Fill out & sign online

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Begin with Part I - Athlete Information. Fill in the student's name, school year, address, gender, grade, school, date of birth, and birthplace. Ensure all fields are accurately completed.
Proceed to Part II - Medical History. Both parent and student should check 'YES' or 'NO' for each medical question. If any questions are answered 'YES', provide explanations in the designated area.
In Part III - Physical Examination, leave this section blank for the authorized health care provider to complete during the physical exam. Ensure they fill out all necessary details regarding the student's health status.
Move to Part IV - Consent Information. Read through the consent statements carefully and ensure both student and parent/guardian sign where required.
Finally, complete Part V - Acknowledgment of Risk and Emergency Permission Form. Fill in all required information including emergency contact details and signatures from both student and parent/guardian.

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