Before practicing, scrimmaging or competing at a PIAA member school in any school year, a student must complete this Comprehensive Initial Pre-Participation Physical Evaluation. Parents and the student complete Sections 1 to 5, an Authorized Medical Examiner completes the Section 6 exam and certification, and the principal or designee keeps the pages. Later sections handle re-certification for subsequent sport seasons and the wrestling minimum weight.
The parent completes Sections 1 and 2, the student and parent complete Sections 3 to 5, and an Authorized Medical Examiner (MD, DO, PA-C, CRNP or school nurse practitioner) completes Section 6. The parent completes Section 7 for later seasons, an MD or DO signs Section 8, and an AME certifies Section 9.
The parent enters the student's name, sex, date of birth, age, grade, school year, address, phones and email, and the fall, winter and spring sports. The emergency block lists parent and secondary contacts, medical insurance carrier and policy number, the family physician (MD or DO), allergies, health conditions emergency personnel should know about, and prescription medications with the conditions they treat.
The parent signs consent for each sport the student may play during the school year. Parent and student then sign six statements: understanding of PIAA eligibility rules, release of school records from seventh grade, use of name and likeness, consent to emergency medical care, with the parent agreeing to pay its costs, and confidentiality of the CIPPE information within the school.
This page explains what a concussion is, its symptoms, and what students should do, including evaluation by an MD or DO sufficiently familiar with current concussion management who decides when the student may return. Student and parent each sign an acknowledgment that they understand the risks, including continuing to compete after a concussion.
This page describes sudden cardiac arrest warning signs and Act 73, Peyton's Law, under which parents may request an ECG as part of the physical at their expense. It states that a student with signs or symptoms must be removed from play and cleared in writing by a licensed physician, certified registered nurse practitioner or cardiologist before returning. Student and parent sign and print their names.
Fifty questions, answered by the student and parent, cover sports restrictions, ongoing conditions, medicines and allergies, fainting or chest pain with exercise, heart tests and family heart history, injuries and fractures with a body-area diagram, atlantoaxial instability, asthma, missing organs, mono, skin infections, concussion, seizures, heat illness, sickle cell, vision, weight and eating, and menstrual history. Yes answers are explained at the bottom, and student and parent both sign.
Record height, weight, optional body fat, brachial blood pressure, resting pulse, vision and pupils; further evaluation by the primary care physician is recommended above age-based limits printed on the form. Mark medical items, including femoral pulses and Marfan stigmata, and musculoskeletal regions normal or abnormal. Certify review of the history, then check cleared, cleared with recommendations, or not cleared for collision, contact, non-contact, strenuous, moderately strenuous or non-strenuous sports, with the reason. Sign with license number and credential.
For each later sport season in the same school year, the parent completes this supplemental health history no earlier than six weeks before the first practice day. It records changes to personal and emergency information and asks six questions about serious illness or injury treated by an MD or DO, concussion, dizzy spells or blackouts, unexplained breathing problems or chest pain, new prescriptions and concerns. The principal or designee reviews it.
Completed by an MD or DO for a student treated by a physician after Sections 1 to 5, or with a yes answer in Section 7. Review Sections 5 and 6, and Section 7 when it triggered this form, list the conditions treated, then sign either A, general clearance for the rest of the school year, or B, limited clearance with up to four restrictions. A concussion clearance requires familiarity with current concussion management.
Before a student wrestles, an AME certifies the minimum wrestling weight, set no earlier than six weeks before the first regular season contest and no later than the Monday before it. An assessor records urine specific gravity (not greater than 1.025), body weight, body fat and the weight from the NWCA Optimal Performance Calculator. Body fat below 7% for males or 19% for females needs AME consent. The AME signs with credential and license number.
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PIAA Comprehensive Initial Pre-Participation Physical Evaluation (CIPPE)
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An Authorized Medical Examiner, who circles MD, DO, PAC, CRNP or SNP (school nurse practitioner) beside the signature and adds a license number, address, phone and the certification date of the CIPPE. Section 8 re-certification is narrower: only a licensed physician of medicine or osteopathic medicine, MD or DO, may sign it.
The CIPPE may not be authorized earlier than May 1. Once done, it is effective for the school year regardless of when it was performed, until the later of the next April 30 or the end of the spring sports season. Students joining later sports that year use Section 7 rather than a new CIPPE.
Section 8 is needed for any student who required treatment from an MD or DO after completing Sections 1 to 5, and when a Section 7 supplemental history question is answered yes or circled. The physician first reviews Sections 5 and 6, and Section 7 if applicable, then gives general or limited clearance.
Yes, for the family sections. PIAA posts the parent and student sections in Spanish as a PDF and a Word file, updated in August 2026. The examiner sections, including Section 6, Section 8 and Section 9, are in the English form, which PIAA also offers as a Word document.