personal insurance / purchase school insurance / accident insurance / stolen equipment / transportation / low energy / insurance / insurance waiver / accident insurance program / insurance program / /
MedicalCondition
loss of consciousness / apparent head injury / Headaches / fainting / Amnesia / brain injury / severe brain swelling / Any knee injury / Nausea / hit Seizures / Every injury / groggy Drowsiness / greater injury / Any dizziness / impact syndrome / Fatigue / brain injuries / injury / Any ankle injury / recurrent illness / heat stroke / potential serious injury / Neck pain / frequent headaches / neck injury / injuries / head injury / /
MedicalTreatment
knee surgery / surgery / /
Organization
Athletic Board / Chehalis Middle School / Washington Interscholastic Activities Association / No__________ School / CHEHALIS SCHOOL DISTRICT / Wildcat Bulletin Board / other authorized school district / Chehalis School / Yes__________ No__________ School / Athletic Director’s Office / District Athletic Office / W.F. West High School / / /
Position
Athletic Director / substance abuse counselor / appropriate counselor / PHYSICAL EXAMINATION Physician / coach/advisor for more information / student/athlete / Athletic Director of the infraction and contacting the parents / youth athlete / athlete / physician / teenage athlete / District Athletic Director / coach / young athlete / SPECIAL REGULATIONS A. General / student-athlete / concussion Any athlete / Name /
CHEHALIS SCHOOL DISTRICT #302 Grade__________ ATHLETE (Print):______________________________________________ Date of Birth:_______________ Last First