PLEASE COMPLETE AND UPLOAD THIS FORM: 

Physical Examination-Vaccination Record

A PHYSICAL EXAMINATION BY A LICENSED HEALTHCARE PROVIDER MUST BE DOCUMENTED ON THIS FORM.

THE EXAMINATION MUST TAKE PLACE NO MORE THAN 12 MONTHS PRIOR TO ATTENDANCE.

AN OFFICIAL PRINTED REPORT OF THE EXAMINATION CAN BE SUBSTITUTED, BUT MUST GIVE ALL THE INFORMATION THIS FORM ASKS FOR.

ALL INFORMATION ASKED FOR ON THIS FORM IS REQUIRED BY LAW.