WIAA Physical Extension Form

The sole purpose of this form is to allow an extension of a student’s physical during the Coronavirus pandemic only if/when the student’s local primary care physician is unable to provide a NEW physical for the student that already has an existing physical on file with the school. This form is to be completed by the parent of the student-athlete. While the student’s physical time period will be extended, it is expected that the student does get a physical by their primary care physician as soon as possible. Under no circumstances will this extension be valid beyond the 2020-21 school year. To participate on a school-sponsored interscholastic athletic team or squad, a student 1) whose physical examination was completed, 2) whose physical is on file with the school, and 3) whose local primary care physician is unable to provide a new physical, must submit this form to the school. This health history update questionnaire must be completed and signed by the student’s parent or guardian for review by the school athletic director and/or school nurse. Any student who does not have an existing physical on file with the school will require a physical with their primary care physician before participating in practice and competition. (ie: freshman who did not have a middle school physical or senior who did not have a physical since freshman year). This form is not to be used for those students.

WIAA-Physical-Extension