FCPS Athletic Training Program Forms
Virginia
High School League Pre-Participation Physical
Form
NEW in 2007-08. This form is still the only form accepted for the 2008-09 season. This form is required to be
completed by the athlete, parent and physician (MD, DO,
PA or Nurse Practitioner) prior to participation in any
sport.
Assumption of Risk for Skin Infections Form
This form outlines the risks of skin lesions and prevention strategies for reducing the risk of transmitting skin disease in the athletic setting. A copy of the form signed by the athlete and a parent must be on file at the school.
Physician
Release for Wrestler with Skin Lesion Form
Form must be signed by MD or DO if wrestler has skin lesion.
Virginia
High School League Unconscious Athlete Physician's
Statement
This form must be signed by
physician following an unconscious, or apparently
unconscious player as determined by game
officials.
Physician's
Response Form
This form is
completed by physician to relay important information
back to the athlete's Certified Athletic Trainer
regarding specific information regarding the athlete's
condition, participation status, rehabilitation
protocols, etc.
Parental
Consent Form for Release of Medical Information to Certified
Athletic Trainer
Form
completed by parent authorizing athlete's treating
physician to release medical information pertinent to the
injury/condition.
Physical
Therapist Response Form
Form
completed by athlete's treating physical therapist to aid
in coordinating treatment in athletic training
facility.
Emergency
Care Card (FCPS document)
Emergency
Care Card is often required by the school to have on file
with the certified athletic trainer as well as each
coach. This form should be updated in the event any
contact numbers change, insurance information changes
and/or any conditions such as asthma, anaphylaxis, etc
changes during the course of a sports season or school
year.
Inhaler
Authorization Form
FCPS form
to be completed by parent authorizing the use of an
inhaler for asthma during the school day or during sports
participation.
Epinephrine
Pen Authorization Form
FCPS form
to be completed by parent and physician authorizing the
use of an EPI-PEN during the school day or during sports
participation.
Medication Authorization se63
Release and indemnification Agreement
Administration of Medication se66
Health Information Form se71
Individual Health Care Plan
Cast
Rule Form for FOOTBALL
Form MUST be completed for athletes to participate in a
contest with a cast or splint located on the elbow to
fingers which is hard in its final form.
Cast
Rule Form for SOCCER
Form MUST be completed for athletes to participate in a
contest with a cast or splint located on the elbow to
fingers which is hard in its final form.
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