TO: All Butler Area Student
Athletes and Parents/Guardians
DATE:
SUBJECT: 2011 – 2012 Physical Procedure
The
All
students interested in participating in athletics at Butler Area School
District for the 2011 – 2012 school year are required to undergo a comprehensive
physical evaluation for participation in his/her first sport of the school
year, sign an Insurance Waiver Form, NovaCare Form, and complete an Eligibility
Questionnaire Form. The CIPPE forms,
Insurance Waiver form, Eligibility form, and NovaCare form are available to
download from our website at www.goldentornadosports.net, and then
click on “physical forms”. All forms may
be picked up at the Athletic Office or at any of the three secondary
buildings.
To
be eligible to play a sport during the 2011 – 2012 school year, the initial
CIPPE physical evaluation form must be completed no earlier than June 1, 2011. Any CIPPE physical turned in after that date
will be valid ONLY for the 2011 – 2012 school year. After June 1st of 2012, a new comprehensive
physical will be required regardless of when the physical was performed during
the school year. This comprehensive
evaluation can be performed at your family physician’s office or with our
school doctors when the district offers the physical in July “ONLY” for the
entire school year. (see attached schedule). There will be a $15.00 fee for physicals when
done at the school district. If you decide to have your primary care physician
perform the physical evaluation, please make sure that the CIPPE forms are the
only form provided to your doctor. When
making an appointment with your family doctor, please take all physical forms
to the authorized medical examiner and have him/her fill out Section 4 of the
evaluation.
Note:
PIAA
PIAA Butler Sports for grades 9-12: Golf, Bowling, Tennis, Rifle,
Swimming, Lacrosse and Indoor Track.
All
forms must be sent directly to the Athletic Office, “NOT” the coach, as soon as
completed, but at least one week prior to the first day of practice. Physicals turned in at the last minute may
result in the student not being permitted to practice or to participate in
tryouts. Such delays may result in a
loss of tryout time or perhaps losing the opportunity to tryout completely. Physicals will not be accepted after the
start of the PIAA defined season unless approved by the Athletic Director. Once the physical is turned into the Athletic
Office and reviewed for eligibility, the student will be granted permission to
participate in athletics. When a
student athlete has a desire to participate in a sport that has roster
reductions or cuts, it is imperative they have all of their paperwork submitted
in a timely fashion.
For
any athlete participating in multiple sports seasons, please follow the
guidelines on page one for the initial CIPPE for the first sport season. For the 2nd and/or 3rd
sport season, or if the physical was performed 6 weeks prior to the start of
the PIAA defined season, the parent/guardian and student will need to
re-certify their contact information and health assessment on Section 5. Your
doctor does not need to re-certify any information unless there has been a
change in the student-athlete’s health or if he/she has sustained a serious
injury since the initial evaluation. If
you check or circle yes to any of the questions on the “Supplemental Health
History” Form on Section 5, you are “required” to go to a certified by licensed
physician of medicine or osteopathic medicine and have him/her complete Section
6 prior to being eligible to participate in the next sports season.
If
so, please schedule an appointment as soon as possible so there is no delay in
eligibility and participation for the next sport season. If you are going to a different doctor other
than the one who performed the original comprehensive physical (CIPPE), you
must also take a copy of sections 1, 2, 3, 4, and 5 with you to your personal
physician so they can complete Section 6. Without Section 6, you are not
permitted to try out, practice, or play.
Lastly,
the Butler Area School District Athletic Department mandates that all students
in grades
9-12
participating in football, soccer, wrestling, basketball, baseball, softball
and lacrosse complete the UPMC Impact Concussion baseline-testing program prior
to the first day of official practice as outlined by the PIAA. This innovative process known as IMPACT,
which stands for Immediate Post Concussion Assessment and Cognitive Testing, is offered by the
If further information is necessary, please
contact the Athletic Office at 724-214-3232.
START DATE FOR PIAA SPRING
SEASON IS
PHYSICALS
LOCATION:
COST:
$15.00 Cash or Check made
out to the
Schedule for School
Physicals for
Schedule for School Physicals for