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CIPPE Section 7 - Re-certification by parent/guardian form. 2025

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This document outlines the re-certification process for student athletes by their parents or guardians, requiring completion of a health history form prior to participation in sports. It includes sections for personal and emergency information updates, as well as supplemental health questions that must be answered regarding any recent medical issues. If any health concerns are indicated, further certification from a licensed physician is required.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the student's name and date of birth. Ensure accuracy as this information is crucial for identification.
Indicate the student's gender and age on their last birthday, followed by selecting the winter and spring sports they will participate in.
Review any changes to personal information, including current home address and telephone numbers for both the parent/guardian and student.
Update any emergency contact information, ensuring that all details are current and accurate.
Complete the supplemental health history section by circling 'Yes' or 'No' for each question. If you answer 'Yes' to any question, provide explanations at the bottom of the form.
Finally, ensure both the student and parent/guardian sign and date the form to certify that all information is true and complete.

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