2018-2019 Sports Physical Packet


    Dear Parents and/or Guardians:

    Please read all of the physical packet forms carefully.  Follow all directions and fill in the forms completely.  Parents/Guardians must fill out and/or sign on 12 different pages throughout the packet, including 2 Sudden Cardiac Arrest acknowledgement forms and 2 Concussion Awareness forms.  

    There are 27 pages in this packet, including this cover letter.  Page 8 is the form for your physician to fill out.  Pages 9 & 10 are UPMC Consent to Treat and HIPAA forms.  Pine-Richland School District contracts athletic training services through UPMC Sports Medicine.  These forms are required by the athletic training staff.  Sudden Cardiac Arrest information and signatures can be found on pages 11 – 14.  Signatures for Concussion Awareness are required on pages 18 and 20.  Pages 21 – 27 contain additional information on concussions and answers to frequently asked questions.

    All forms must be signed and turned in to the Athletic Department before a student can try out for or participate in a sport.  NO EXCEPTIONS WILL BE MADE.

    You may choose to have your student’s sports physical exam conducted at your private physician’s office.  THE EXAM CANNOT HAVE TAKEN PLACE PRIOR TO JUNE 1, 2018.  This is a PIAA state rule.  The physician must fill out Page 8 of this packet, and you must turn in the entire completed packet by August 6, 2018, if participating in a fall sport.  Your student will not be allowed to try out or practice without a completed physical packet on file. 

    • Fall Sports Physicals MUST be turned in by August 6, 2018 for the opening of Fall Sports on Aug. 13, 2018.
    • Winter Sports Physicals MUST be turned in by November 9, 2018 for the opening of Winter Sports on Nov. 16, 2018.
    • Spring Sports Physicals MUST be turned in by February 25, 2019 for the opening of Spring Sports on March 4, 2019.

    In addition, all sports physical exams must take place within the Commonwealth of Pennsylvania.  OUT-OF-STATE PHYSICAL EXAMS WILL NOT BE ACCEPTED.  Please mail all forms to the Pine Richland Athletic Office, Pine Richland High School, 700 Warrendale Road, Gibsonia, PA   15044, or drop off at the high school front office.

    All sports physical exams must be completed using the forms in this packet.  Other physical exam forms will not be accepted.

    ATHLETIC INSURANCE INFORMATION:  In the event that your child is injured, we would like to make certain that you are aware of school district procedures regarding injuries to athletes. 

    • The school district has purchased accident insurance for students participating in the interscholastic athletic programs, cheerleading and band members. The insurance purchased by the school district covers the first $100 of qualifying medical expenses.
    • After the first $100, the student’s family insurance, if any, becomes the primary insurance. Should the limits of the student’s family insurance be exceeded, the insurance purchased by the school district will continue to cover qualifying medical expenses to the limits of the insurance.
    • In case of an athletic injury, the student or parent/guardian should obtain an insurance claim form from the Athletic Office and should complete it by following the printed directions, which accompany the claim form. This form must be submitted within ninety (90) days from the date of the injury to:

    Goodwin & Gruber Agency, Inc.

    Attn:  James Gruber
    300 McKnight Park Drive
    Pittsburgh, PA   15237

    All Physicals for the 2018-2019 school year must be dated on or after June 1, 1018.