The DIAA pre-participation physical evaluation and consent form consists of seven pages. Pages two, three and five require a parent’s signature while pages six and seven are references for the parent and student athlete to keep. Page four requires the exam date and physician’s signature and page five requires the clearance to participate date and physician’s signature. The student must be cleared to participate on or after April 1 based on a physical examination conducted within 12 months of the signature. The clearance is valid through June 30 of the following school year unless a re-examination is required.
- Please refer to COVID information from Center for Disease Control and Prevention (CDC) and Delaware Department of Public Health (DPH) for latest health and safety information.
- On the history form (page 3), all questions should be answered based on complete medical history (not just in the last year).
- On the physical form (page 4), a section for date of clearance has been added next to the “signature of health care professional”. The date the forms are filled out does not have to be the same day that the physical was performed. See above for timing of physical.
- The date the forms are filled out does not have to be the same day that the physical was performed. See above for timing of physical.