In-House Physical Information




TO:                  Athletes and Parents/Guardians


FROM:            Athletic Department


DATE:            April 19, 2019




Dear Parents/Guardians:

On June 4th and 5th, from 6 to 8pm Cumberland Valley and Orthopaedic & Spine Specialists (OSS) will offer physicals to athletes participating in sports for the 2019-2020 school year. The line will begin outside the athletic office at the high school.  The physical packet must be fully completed in order to proceed.  The cost is $15.  We accept cash or checks made out to CV Athletics.


The Pennsylvania Interscholastic Athletic Association (PIAA) has developed procedures for obtaining a Comprehensive Initial Pre-Participation Physical Evaluation (CIPPE).  This process is as follows:

  • All athletes MUST have a completed 6-page physical packet, containing the CIPPE, dated June 1st, 2019 or later in order to be eligible to participate in interscholastic athletics during the 2019-2020 school year.  Physicals dated prior to June 1st, 2019 WILL NOT be valid.
  • The 6-page PIAA CIPPE packet can be obtained on the CV website under the Athletics page, then click Athletic Training, scroll to sports physical form.  Additional forms needed: Risk of Injury form and Random Drug Testing forms. 
  • Please have a payment of $15 in cash or check made out to the CV Athletics
  • Physicals will take place at the high school, and the start line is outside the Athletic Office
  • The physicals will be filed with the Athletic Trainers, please let us know at the check-in desk if you need a copy for your records.

Co-curricular physical screenings, for students who will be in grades 7 through 12 and participating in interscholastic athletic programs during the 2019-2020 school year, will be conducted at Cumberland Valley High School according to the following schedule:

Tuesday – June 4, 2019

(Athletes Last Name A through L)

6:00 – 6:30 PM – Athletes A-B-C

6:30 – 7:00 PM – Athletes D-E-F

7:00 – 7:30 PM – Athletes G-H-I

7:00 – 8:00 PM – Athletes J-K-L

*Physicals take at least an hour to be completed

Wednesday – June 5, 2019

(Athletes Last Name M through Z)

6:00 – 6:30 PM – Athletes M-N-O

6:30 – 7:00 PM – Athletes P-Q-R

7:00 – 7:30 PM – Athletes S-T-U-V

7:30 – 8:00 PM – Athletes W-X-Y-Z

*Physicals take at least an hour to be completed

All students are asked to wear shorts or loose fitting pants to be able to check the knee area

Please Note:  No appointment is necessary, just show up during your time slot.  Students who do not show up as scheduled will be asked to wait until scheduled athletes are completed.  If it is necessary that the time and/or date be changed you MUST contact Sheila Mueller (preferably by text) at 717-422-4737. **************************************************************************************************                                          

                                                         Instructions for completion of athletic packet


Section 1:       Personal and Emergency Information – This form provides information to the CV School District in the event of an emergency situation.  Every student is required to complete this form and have it on file prior to participating in any interscholastic sport.


Section 2:       Certification of Parent/Guardian – This form grants the athlete permission to participate in the CV Interscholastic Athletic programs.


                        (1)  Parent or Guardian signatures are required beside each sport in which student intends to participate or “try-out”, and

                        (2)  Parent or Guardian signatures are required on FIVE LINES (B THROUGH F) designated at the bottom of the form.


Section 3:       Understanding the Risk of Concussion and Traumatic Brain Injury – This forms provides information on Concussions and Traumatic Brain Injuries that may be sustained as a part of participating in the CV Interscholastic Athletic program.  Parent/ Guardian and Student must sign and date this form at the bottom.


Section 4:       Understanding the Risk of Sudden Cardiac Arrest Symptoms & Warning Signs – This forms provides information on Sudden Cardiac Arrest Symptoms and Warning Signs that may be sustained as a part of participating in the CV Interscholastic Athletic program.  Parent/ Guardian and Student must sign and date the bottom of this form.


Section 5:       Health History – This form provides information that the doctors need before they conduct the physical exam.  All questions must be answered and dates noted as requested.


Section 6:       PIAA Comprehensive Initial Pre-Participation Physical Evaluation and Certification of Authorized Medical Examiner – This form is for the physical examination and must be signed by a PHYSICIAN.  This is the only form that will be accepted as a valid physical examination.  Please complete student’s name, age, grade, and sport at the top of the form prior to the exam.

Additional forms needed: Risk of Injury form and the random drug testing forms


Section 7: Re-Certification Form – this is needed for all athletes that participate in a winter and spring sport, unless their physical forms are dated at least 6 weeks prior to the try-out date (please read the top paragraph on section 7 for further information).


Any Private Physical may not be administered prior to June 1, 2019 and must be completed on the Comprehensive Initial Pre-Participation Physical Form – Section 6.


The first day of practice for each season is as follows:


Fall Sports – August 12th (football Aug.5th)

Winter Sports – November 18th

Spring Sports – March 2nd



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