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2018-19 Physical Form

 

Get Cleared Online

La Puente Athletics
Online Athletic Clearance

 

Quick steps for parents/students using the online athletic clearance module.

1. VISIT www.athleticclearance.com and view the tutorial video for a quick reference instructional guide

 

2. CREATE an account. Click the “register” link to start an account.
Note: It’s important that you include a valid email address because email verification is required prior to registration.

 

3. Once you create an account you will have to VERIFY your account by reviewing your email and clicking on the link. (If the email is not in your inbox, make sure you check your junk or spam folder).   After you click on the link, you will be able to start the clearance process.  

 

4. Now LOGIN at www.athleticclearance.com using the username & password you created via the instructions above.  

 

5. SELECT the “New Clearance” button..  

 

6. COMPLETE all required fields for:  

 

STEP #1: Student Information

  • Input Student Name, Birthdate, Grade, Gender, Student ID, Student Email Address (if none, input N/A), Student Cell Number, Student Home Address, and Student Home Phone.  
  • Insurance Information If the student is covered by insurance, click YES & input Name of Insurance Company & Insurance Number.   If student is not covered by insurance, click NO.
  • NOTE: If you do not have insurance then you can purchase it through the school. It is required by the state of CA to have insurance to participate in school sports.  
  • Fill out the attached Medical Insurance Certification along with photocopy of insurance card and turn into Athletic Office or ASB Office.
  • Physician Information List Student Physician Name & Phone Number. If you do not have this information available, list N/A & 000-000-0000.
  • Physical Completed physical must be turned into the ASB office. Only physicals performed by MD or DO licensed physicians will be accepted. Physicals completed by chiropractors (DC) or Physician’s Assistants (PA-C or PA) will NOT be accepted. Physicals MUST have the physician’s signature and stamp to be accepted.
  • Proof of Insurance Using your cell phone take a picture of your insurance card and upload it under “Proof of Insurance”
  • Educational History Select one of the options listed. If your student is a transfer student you will need to meet with the Athletic Director Mr. Lane to complete the Parent/Student Certification Form required by CIF before you are allowed to compete.

 

STEP #2: Medical History

  • Click YES or NO to all of the items listed.
  • Note: If YES is selected, some items may ask for more specific information about the injury or ailment.  
  • STEP #3: Parent/Guardian Information

Input all required information. You may add an additional emergency contact if you choose.

 

STEP #4: Signatures

Complete all 10 Signature forms.  

 

7. PRESS submit and you have now completed the online registration process. All of this data will be electronically filed with the school athletic department for review. -An email will be sent to you upon approval of your student’s forms.  

 

8. PRINT OUT & SIGN the Clearance Confirmation Message. See the Textbook room/Library to be signed off for any bills before returning the form to the ASB Office. (If you are unable to print at home please see the Library or Mr. Lane for assistance)  

 

9. Turn in the Clearance Confirmation page with your physical to the ASB office. An email confirmation will be sent to you when your student has been officially cleared to participate.  

 

NOTE: SESSION EXPIRATION If you are using a public computer or leave your browser session open, make sure you (a.) save all of your work and (b.) log out to protect your information. The athletic clearance system will automatically expire and log you out of the system, if your session is idle for more than approximately 20 minute.    

 

Scan the QR Code below to visit AthleticClearance.com

 

Questions?  

Contact Mr. Lane the Athletic Director in room 115 ljlane@hlpusd.k12.ca.us or 626-934-6700 x6815

OR

Ms. Ramirez-Bravo the Athletic Secretary in the ASB Office eramirezbravo@hlpusd.k12.ca.us or 626-937-6700 x6733