Athletic Forms

Sports Physicals

Sports Physical Packet Checklist

(Updated for 2021-22 school year)

  • Pre-Participation Physical Evaluation Form - MUST BE DATED AFTER JUNE 1, 2021
  • Athletic Consent Waiver Form (completed by parent/guardian)
  • Medical History Questionnaire Form (completed by parent/guardian)
  • Emergency Contact Form (completed by parent/guardian)
  • Concussion Information Form (completed by parent/guardian)
  • COVID-19 Assumption of Risk and Waiver of Liability (completed by parent/guardian)
  • **Summer/Off Season Athletic Consent Waiver (completed by parent/guardian)

Physical Form (PDF)

*As of June 1st, 2021, all physical forms MUST be submitted online via Healthy Roster. All forms are accessible to be complete online through Healthy Roster webpage and the Physical Form that gets completed by the physician can be also uploaded directly to Healthy Roster. Please refer to the instructions below. No paper forms will be accepted.

**As of June 1st, 2019, any student that does not have a physical completed and on-file with the St. Mary’s Ryken High School Athletic Department must complete a Pre-Season and Summer Workout Consent Form to participate in any SMR Athletic sanctioned event outside of the sports season (i.e., summer workouts, pre-season workouts, team lifting/conditioning). Please complete the form online through Healthy Roster. For incoming Freshmen/Transfers, please click on the link below for the paper form if you don't have your SMR ID number.

Healthy Roster

Instructions for how to access Healthy Roster is found on the Parent Veracross Portal.

Healthy Roster

For questions or problems creating the profile or uploading the paperwork, please contact Athletic Trainer Bailey Clark, at

If you have other athletic related questions, please contact either the coach listed or Jon Lombardo, Athletic Director, at