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Preparticipation Physical Evaluation (PPE) OR  Physical.

This is the same form required by schools and must be completed and signed by a doctor.

Please make sure to download the medical form in PDF or JPEG format. Otherwise, the form will be considered incomplete.

*Por favor, asegúrese de descargar la forma médica en formato PDF o JPEG. De no hacerlo, el formulario se considerará incompleto.


Preparticipation Physical Evaluation (PPE)

Statement of Verification


I hereby declare and affirm that the information contained in the Eligibility Form has been legitimately provided by a physician or qualified healthcare personnel authorized to conduct the examination.



First Dancer's Name
First Name*
Middle Name
Last Name*
First Dancer's Date of Birth*
Date of Birth
First Dancer's Signature*
Second Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Third Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Fourth Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Fifth Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Sixth Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Seventh Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Eighth Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Ninth Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Tenth Dancer's Name
First Name*
Middle Name
Last Name*
Dancer's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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PREPARTICIPATION PHYSICAL EVALUATION (PPE) or Sport Physical.
*Please make sure to download the medical form in PDF or JPEG format. Otherwise, the form will be considered incomplete. *
  
Valid file types: JPG, GIF, PNG, and PDF
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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