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Sports Physical Sign-Up Form

GET ON THE BALL

Sports Physicals - 7th through 12th grades
Thursday, July 11 and Tuesday, July 23
5:30 - 8:30 p.m.

Capital Region Sam B. Cook Healthplex
1432 Southwest Boulevard, Jefferson City, MO

Pre-registration and parental consent required.
Call (573) 644-7878 for an appointment or sign up below.
Registration begins June 1.

Height/Weight - Blood pressure
Range of Motion/Flexibility - General Exam - Orthopaedic Check (if needed)

Please wear athletic attire to the exam.
Cost: $25.00

The $25.00 fee helps to defer the direct cost of providing the program.

Click Here to Download and print the Pre-participation Evaluation Form
You may fill out the form and bring it with you to your appointment.

The Registration allows All information required.

REGISTRATION
Your Name
E-mail Address
Phone #
First Time Preference    
       
Second Time Preference    
You will be contacted if your selected time(s) is not available.