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)
- Athletic Medical History Questionnaire Form (both student-athlete and parent/guardian sign)
- 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)
*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. Please complete the form online through Healthy Roster. For incoming Freshmen/Transfers, please refer to your teams coach or to the Athletic Trainer’s at St. Mary’s Ryken High School for a hard copy.
Instructions for how to access Healthy Roster is found on the Parent Veracross Portal.
For questions or problems creating the profile or uploading the paperwork, please contact either the Assistant Athletic Director/Director of Athletic Training David "DJ" Hayes, at firstname.lastname@example.org or Athletic Trainer Bailey Clark, at email@example.com.
If you have other athletic related questions, please contact either the coach listed or Jon Lombardo, Athletic Director, at firstname.lastname@example.org.
On Campus Physicals
Every year, SMR offers physicals on campus for a fee of $20 (cash or check made payable to St. Mary’s Ryken High School). Our team physicians will complete a comprehensive physical examination with the SMR Sports Medicine staff.
Dates for the 2021-22 season:
Saturday, July 31st from 10 a.m. – 1 p.m.
Saturday, August 7th from 10 a.m. to 1 p.m.
Location: Donnie Williams Center, Athletic Training Room, Lower Level
All students receiving a physical must bring a signed copy of the “On Campus Physical Parent Permission Form”.
If you have any questions, please contact Athletic Trainer, Ms. Bailey Clark at email@example.com or 301-373-4161.