• 2022-2023 SCHEDULED PIAA START DATES AND DUE DATES FOR COMPLETED CIPPE PACKETS, UPMC FORMS AND PHYSICAL EXAMS

    Fall Athletics:

    Due date for forms:   August 8, 2022

    First day of fall sports: August 15, 2022

     

    Winter Athletics:

    Due date for forms: November 7, 2022

    First day of winter sports: November 18, 2022

     

    Spring Athletics:

    Due date for forms: February 27, 2023

    First day of spring sports: March 6, 2023


     

  • GENERAL GUIDELINES FOR PARENTS: CIPPE FORMS

    The new PIAA physical exam packet contains several pages and it is imperative that the Parent/Guardian of the student athlete complete all sections in their entirety.  It's important that the UPMC forms are completed with this information as well.  This will allow our training staff to treat your child in case of an injury.

    • Packets can be picked up in the Athletic Office, Nurses office or downloaded from pdf below
    • After completing the packet-in pen- make a copy for your records and turn in the original
    • No Athlete will be permitted to participate without completing the CIPPE and UPMC forms.  They must be turned into the athletic office prior to the start of the system.  

    SECTION 1: Personal and Emergency Information

    Please fill in all information regarding:

      • Emergency contact and health insurance, including policy number and phone number
      • Family physician's name, address and phone number

    SECTION 2: Certification of Parent/Guardian 

    Please sign beside EVERY sport your student might be interested in playing for the year

    Please sign and date ALL sections A-F

    SECTION 3: Understanding of Risk of Concussion and Traumatic Brain Injury

    The student athlete and parents must read and understand the facts concerning concussions.

    The student athlete and parents must sign and date the concussion form

    SECTION 4: Understanding Sudden Cardiac Arrest Symptoms and Warning Signs

    The student athlete and parents must read and understand the facts concerning cardiac arrest

    The student athlete and parents must sign and date the cardiac arrest form

    SECTION 5: COVID-19

    The student athlete and parents must sign and date the Supplemental Acknowledgement, Waiver and Release: COVID-19

    SECTION 6: Health History

    Complete to the best of your knowledge as pertaining to the student athlete.  Student athlete and parents must sign and date.

    SECTION 7: CIPPE and Certification of Authorized Medical Examiner

    Examining physician will complete this section during physical examination.  If you choose to have the physical completed by your own doctor, please follow the steps outlined below:

      • A licensed medical practitioner must conduct exams
      • All physicals must be completed after June 1 to be eligible for the following school year's athletic programs  (i.e. Complete by June 1, 2022 for 2022-2023 school year participation) 
      • Have the physician sign, date, and fill in address/phone # at the bottom of the page
      • Please turn the completed form in as soon as possible to your coach, athletic trainer or school nurse

    SECTION 8: Re-certification by Parent/Guardian

    If any "Supplemental Health History" questions are answered YES, please explain at the bottom in the space provided and have your child re-certified by a licensed physician.  Please specify dates where applicable and be as descriptive as possible. 

    The student athlete and parent/guardian must sign and date the form. 

    SECTION 9: Re-certification by Licensed Physician of Medicine or Osteopathic Medicine

    Must be completed by a physician only if you had answered YES to any of the "Supplemental Health History" questions at the bottom of the page on Section 8.

    SECTION 10: Minimum Wrestling Weight

    Prior to the participation by any student in interscholastic wrestling, the Minimum Wrestling Weight (MWW) at which the student may wrestle during the season must be (1) certified by an Authorized Medical Examiner (AME) and (2) established NO EARLIER THAN six weeks prior to the first Regular Season Contest day of the
    wrestling season and NO LATER THAN the Monday preceding the first Regular Season Contest day of the wrestling season.


     

    ADDITIONAL FORMS TO BE COMPLETED BY PARENT/GUARDIAN AND ATHLETE

    To treat your child, UPMC Athletic Training Services requires the following forms to be completed: 

      • UPMC Authorization for release of Protected Health Information 
      • UPMC Consent for Treatment and Healthcare Information
      • UPMC Privacy Practices
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Last Modified on June 1, 2022