Physical Registration Form

Extracurricular Physicals Free for Manor Students

PLEASE READ CAREFULLY Thank you for your interest in participating in Manor ISD extracurricular actitivities. Our goal is to help ensure that your scholar is prepared for the upcoming year and cleared physically to participate in their UIL activity.

Scholar's Name

First NameMiddle NameLast NameSuffix

What is your student ID number?¿Cuál es su número de identificación de estudiante?

Birth Date - fecha de naciemento

MonthDayYear

Home Address

Street Address

Street Address Line 2

CityState

Zip Code

What school will you be attending in the fall?

Grade Entering this Fall

Sport or Activity will you will be participating in

Primary E-Mail (Note: this is the email account that you will receive parent correspondence )

example@example.com

Parent/Guardian name

First NameMiddle NameLast NameSuffix

Parent/Guardian Phone Number

Format: (000) 000-0000.

Emergency Contact

First NameMiddle NameLast NameSuffix

Phone Number

Format: (000) 000-0000.

Informed Consent/General Release:

All documents must be signed by the parent or legal guardian. If you have not completed the information on Rank One, this may delay you from getting your physical at your scheduled time. If you have any questions please reach out to to the Athletic Coordinator at your school. Manor - Coach James Keller, MNTHS- Coach Derrick Williams

Please bring a current immunization record to your appointment. Please wear comfortable clothing or work out clothes for the physical.

Please print the physical form out and bring it with you. Page 1 should be filled out completely prior to the physical and a student and parent signature at the bottom of the page.

UIL Physical Form (English)

UIL Physical Form (Spanish)

Click the link below to access Rank One's online forms. They must be completed and signed prior to your physical appointment. All forms will be reviewed prior to your appointment time and you will not be able to proceed to your appointment until the documents are complete and signed. Please print out both pages of the form and bring it to the appointment.

Contact Kristin Striemer, Assistant Athletic Director, with any questions or problems.

Rank One Online Forms - For students who are participating in Athletics only.

Please note that if forms are not completed and signed by the parent, the parent will need to be present to sign the forms prior to the physical appointment.

Thank you

Consentimiento informado/Divulgación general:

Todos los documentos deben estar firmados por el padre o tutor legal. Si no ha completado la información sobre el rango uno, esto puede retrasar su examen físico a la hora programada. Si tiene alguna pregunta, comuníquese con el coordinador atlético de su escuela. Manor - coordinador Coach James Keller, MNTHS- coordinador Coach Derrick Lewis.

Traiga un registro de vacunas actual a su cita. Por favor use ropa cómoda o ropa deportiva para el físico.

Imprima el formulario físico y tráigalo con usted. La página 1 debe completarse completamente antes del examen físico, incluida la firma del estudiante y del padre en la parte inferior de la página.

Formulario físico de UIL (inglés)

Formulario físico UIL (español)

Haga clic en el enlace a continuación para acceder a los formularios en línea de Rank One. Deben completarse y firmarse antes de su cita física. Todos los formularios serán revisados antes de la hora de su cita y no podrá proceder a su cita hasta que los documentos estén completos y firmados.

Imprima las dos páginas del formulario físico y tráigalo a la cita. Comuníquese con Kristin Striemer, Asistente de dirección atlética con cualquier pregunta o problema.

Formularios en línea de rango uno - Solo para estudiantes que participan en atletismo.

Tenga en cuenta que si los formularios no están completados y firmados por los padres, los padres deberán estar presentes para firmar los formularios antes de la cita física.

Gracias

By my eSignature below, I certify that I have read, fully understand and accept all terms of the foregoing statement. Please signify your acceptance by entering your full name in the box below

Con mi firma electrónica a continuación, certifico que he leído, comprendido y aceptado todos los términos de la declaración anterior. Por favor, indique su aceptación escribiendo su nombre completo en el recuadro a continuación.

Parent's eSignature

Appointment Please arrive 30 minutes before your schedule appointment time.