AGENCY: Department of Health. Bureau of Health Promotion

SERIES: 81911
TITLE: Pre-athletic interim health questionnaire
DATES: 1985-
ARRANGEMENT: alphabetical by school district

DESCRIPTION: This is a parental consent form to allow a student to continue to participate in interscholastic athletics without a second physical examination. This report is sent to the state for statistical purposes. This form includes the student's name, date of birth, school, and date of last physical examination; any changes to the student's health since the last physical; and the signature of the parent.

RETENTION

Retain for 1 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 06/1987

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

Administrative

This record is a duplicate copy. The original is kept in the school's athletic files. This record therefore has only administrative value.

PRIMARY DESIGNATION

Private