Dear Parent(s)/Guardian(s),

Welcome to Providence! If your son or daughter is interested in playing sports this school year please read below. This form only needs to be completed if your child will be attending our free physical event and you will not be accompanying them to their appointment.

PRIOR to athletic participation in tryouts, practices, games or summer athletic camps or competitions. an individual must have a current Annual Pre Participation Physical Exam (PPE) on file at his/her school as well as our athletic clearance packet and an ImPACT Baseline Concussion Test.

You are more than welcome to have your child obtain their athletics pre-participation physical exam from their primary care doctor or pediatrician, however, the physical must be completed on our school physical form which is located on our public website on the athletics tab under “Athletics Physical Clearance Documentation”. Your child’s PPE and the remainder of the required clearance documentation will still need to be completed by a parent or guardian and submitted into SportsWare. For access to SportsWare, instructions on how to submit our required athletics clearance documentation as well as schedule your child's ImPACT baseline concussion test please send our Athletic Trainer, Sonnie DaCosta, an email at sonnie.dacosta@providencehigh.org

In order to assist our student athletes and their families, this year Providence High School will offer free sports physicals conducted by qualified medical providers from Exer Urgent Care. The exams will be conducted on Saturday May 12th from 8am - 12pm at the Exer Urgent Care Northridge location and from 1pm - 5pm at the Exer Sherman Oaks location and on Saturday June 9th from 8am-12pm at the Northridge location only.

Once again, if your child signs up for an appointment on one of the days listed above, their physical will be free of charge. They will also receive either a snack and a "goodie package" as well. Exams are free, but if you choose to do so you can make a $25 donation at the time of your child's appointment. 100% of the donations collected will go to Providence St. Joseph Medical Center Level III Neonatal Intensive Care Unit (NICU)

Your presence ƛǎ ƘƛƎƘƭȅ NJŜŎƻƳƳŜƴŘŜŘ during the exam, but iŦ ȅƻdz ŀNJŜ dzƴŀōƭŜ tƻ accompany your student-athlete LJƭŜŀǎŜ ƳŀƪŜ ǎdzNJŜ ǘƻ ǎƛƎƴ ŀƴŘ ŘŀǘŜ ǘƘƛǎ ŘƻŎdzƳŜƴǘ at the bottom of this page ŀƴŘ ƘŀǾŜ ȅƻdzNJ ŎƘƛƭŘ ōNJƛƴƎ ƛǘ ǿƛǘƘ ǘƘŜƳ ǘƻ ǘƘŜƛNJ ŀLJLJƻƛƴǘƳŜƴǘ. To make an appointment for a free Pre-participation exam with our Exer Urgent care provider for either of the dates listed above please go to http://www.exerurgentcare.com/exer-sports-schools/

Once you have reached this page scroll to the bottom orange box titled "2018 Sports Physical Day School Lookup" and click Providence High School. Select the date you would like to sign up for (please make sure you select your preferred location - either Northridge or Sherman Oaks on 5/12/18 or Northridge on 6/9/18) click "Sign up" next to the desired location and date and then click "Submit and Sign Up" then select your desired appointment time and enter the required information then "Sign Up Now". If your child is unable to attend one of the free physical dates listed above you may also call any Exer location for a physical appointment and let them know your child is a PHS student and the cost for their physical will be at the discounted price of $45.

Physical exams will not be completed without this signed letter or the accompaniment of a parent/guardian. I give my permission for my son/ daughter ____________________________ to be examined by an Exer medical provider without my presence. ONLY SIGN BELOW IF PARENT WILL NOT BE PRESENT AT THE TIME OF THE EXAM

____________________________ ________________________________ _________ Printed Name Signature Date