ATHLETIC FORMS

Athletic Forms Checklist (Print this first!)

Physical Form (1st and 3rd year - Physician must sign)
Alternate Year Physical Form (2nd and 4th year)

NDA Permission to Treat
Concussion Management Signoff Form
Prevea Clinic Consent to Treat
Athletic Code Exam Scan Sheet  (Form to enter answers located on the last page of exam)
Travel Consent Form


The following forms below need to be read prior to practice. The sign off form is at the bottom of the list.
Athletic Code Acknowledgment
ImPACT Concussion
WIAA Eligibility
FRCC Sportsmanship Code for Parents
FRCC Sportsmanship Code for Athletes
**Please print and sign for each code: Sign Off Form for all codes/forms

Concussions - Forms requesting Academic Accommodations

Concussion Insurance Program

End of season evaluation form


PHYSICALS & ALTERNATE YEAR INFORMATION
All students who plan to participate in a sport at Notre Dame Academy, particularly incoming freshmen, must complete either a physical form or an alternate year card.  Forms may be picked up in the main office or athletic office and returned to the Athletic Department prior to the first day of practice.  The physical exam card must bear the signature or stamp of a physician/clinic along with the exam date.  Physicals are valid for two years; or if a physical taken after April 1, it is valid only for remainder of that school year and the following school year.  Students will not be allowed to practice (or tryout for the team if applicable) until the physical form or alternate year card has been completed and returned to the Athletic Department. 

 

All freshmen need physicals as they begin high school.  If interested, Prevea Sports Medicine Clinic will offer physicals for $20 per athlete at the following:  

Ashwaubenon - Sports Medicine, 2502 S. Ashland Ave, 920-496-4750  
Wednesday, July 13 and Wednesday July 27, 4:30 - 7 pm

Luxemburg-Casco Health Center, 101 School Creek Trail, 920-845-2351  
Tuesday, July 12 and Thursday July 28, 3:00 - 5:30 pm

Howard Health Center, 2793 Lineville Rd, 920-405-1455  
Thursday, July 14, 3:00 - 6:00 pm

Pulaski Health Center, 940 S. St. Augustine St., 920-822-5444 
Thursday, July 14 and Tuesday August 2, 3:00 - 6:00 pm

You need to call in advance for an appointment.   Please call as soon as possible to schedule and avoid any delays in participation.

Also please read the NDA Communique for other Clinic locations and dates when physicals will be offered.


The WIAA rule regarding physicals reads as follows:

A student may not practice for or participate in interscholastic athletics until the school has written evidence on file in it’s office attesting to (a) parental permission each school year and (b) a preparticipation physical fitness form attesting to current physical fitness to participate in sports as determined by a licensed physician, Phusician’s Assistant or Advanced Practice Nurse Prescriber no less than every other school year with April 1 the earliest date of examination.  School policy determines when an athlete may return to competition following an injury, except where rulebook or WIAA tournament policies apply.    (Note)  It is recommended that a student also have dental fitness attested by a licensed dentist.

Physical examination taken April 1 and thereafter is valid for the following two school years; physical examination taken before April 1 is valid only for the remainder of that school year and the following school year.  Physicians may authorize Nurse Practitioners of Physician Assistants to stamp this card with the physician’s signature, or the name of the clinic with which the physician is affiliated.

To recap the requirements for incoming freshmen:
All incoming freshmen must have a physical to participate in athletics at Notre Dame during the 2015-2016 school year.  If this took place after April 1, 2015 it will be good for two years.  Anyone with a physical date before April 1st must contact the athletic director for proper filing of all paperwork.

Reminder – don’t wait until the end of summer.  The physical must be turned in before a student will be allowed to practice for any team.  This rule applies to all sports – football, soccer, cross country, volleyball, golf, tennis, basketball, hockey, baseball, softball, track, and the dance team.