Community Sports League Pre-Participation Evaluation Sheet
Personal Information
Participant Name
Date of Birth
Address
Phone Number
Emergency Contact
Medical History
Condition
Yes
No
Details
Asthma
Diabetes
Heart Problems
Allergies
Other
Current Medications
Physical Examination
Height (cm)
Weight (kg)
Blood Pressure
Pulse
Physician's Clearance
Comments/Restrictions
Physician Name
Signature
Date