Any student wishing to participate in athletic practices, scrimmages or games in the Middletown Area School District (MASD) must, in accordance with the PIAA, complete a Comprehensive Initial Pre-Participation Physical Examination (CIPPE). This form, sections 1-5, must be completed by a parent/guardian and a physician. Athletes will not be eligible to participate in any capacity until sections 1-5 of this form is completed in its entirety.
Physical exams must be dated after June 1st for the upcoming school year. Physicals will be valid until May 31st of that school year unless a recertification is needed. Please note that school sports physicals will only be done over the summer and will not be done again during the school year. Please plan accordingly and plan to attend summer physicals if you plan on playing any sport during the school year. CIPPE’s will not be offered during the school year. Any athlete who does not have a CIPPE done by the school must go to their own family doctor to have it completed. Athletes who play sports in multiple seasons will be required to fill out a recertification form at the beginning of the winter and spring sports season.
Sections 6 and 7 of the CIPPE are recertification forms that must be completed prior to each additional sports season after the initial CIPPE. Section 6 is designed to update the healthcare staff at MASD on any changes or updates to an athlete’s medical history since the time of the initial exam. This form must be filled out in its entirety by each athlete’s parent or guardian. If the athlete has sustained an injury during the previous season, the healthcare staff at MASD may require the athlete to complete section 7, the medical recertification, by their physician. The physician who did the initial CIPPE or another physician who has reviewed sections 1-5 of the initial CIPPE form may complete the recertification and section 7. If the athlete did not have an injury since the initial CIPPE form and has no significant changes to their medical history, they only need to turn in section 6 to update their records and do not need to complete section 7.
Forms are available on this page under Documents & Forms.
All completed forms must be returned directly to the School Nurse prior to the beginning of the season.