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Argyle High School Band Member Packet
Please find included in your packet the following:
-2025 Spring Events Schedule
-2025 Summer Band Schedule
-2025 Fall Performance Dates
-2025 Marching Band Participation Form
-2025 Commitment Contract
-UIL Physical Form
Instructions:
-Carefully read the commitment contract and all information
-Both parent and student should initial next to each point
-Both parent and student should sign the commitment contract
-Both parent and student should sign the 2025 Marching Band
Participation form
Items to turn in once complete to Mr. Fletcher or Mr. Gutic (if
incoming freshmen):
-Confirmation of online payment to Argyle Band Boosters online OR
check of $200 made out to Argyle Band Boosters.
-2025 Marching Band Participation Form
-2025 Marching Band Commitment Contract
-UIL Physical Form (must be completed yearly to participate)
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Greetings, Students and Parents,
Congratulations! Your child is a member of one of the most successful high school band
programs in the United States. The Argyle Band is an 11-time medalist at the UIL State
Marching Contest and an 8-time State Championship organization. In the last four years, the
Argyle Band was the silver medalist in 2018, the gold medalist in 2020, the gold medalist in
2021, a 3-time UIL Area B Marching Champion, and a 3-time Sounds of Springtown Grand
Champion, competing with top 5A and 6A groups in the DFW area. With this recognition, we
look forward to even more outstanding achievements in the year ahead with your child’s
participation and your support! What will your Argyle Band accomplish next with your
involvement?
This guide does not take the place of the Argyle Band Handbook. The design of this guide
is to be a resource to help you navigate your child’s first year in the program.
What is in this guide?
Who are the directors? What is involved in a marching program? What are the competitions,
and how are they judged? Where is the Pit? How is placement decided in the concert
bands? These are just some of the questions answered in the following pages. And please,
if you cannot find the answers here, don’t hesitate to ask a parent who has been here
longer. We are excited to have you join The Argyle Band.
The Directors
Director of Bands
Jason Bird
940-218-3578
jason.bird@argyleisd.com
Associate Director of Bands
Evan Fletcher
evan.fletcher@argyleisd.com
Percussion Coordinator
Christine Mollenkopf
christine.mollenkopf@argyleisd.com
Color Guard Director
Erica King
erica.king@argyleisd.co
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Marching Season: The Fall
Marching Band Terms
Some terms you may not have heard before that you may find confusing:
Auxiliaries or Color Guard: The color guard is the “Flag corp” or dancers on the
field.
The Drumline: Also known as the battery, this group of percussionists plays various
marching percussion instruments (drums, cymbals).
The Pit/Front Ensemble: Also known as the front ensemble, It consists of stationary
percussion instruments such as the marimba, vibraphone, bells, xylophone, chimes,
and instruments that create special effects.
Winds: A broad term for woodwinds and brass. (Example: “wind rehearsal” means
woodwinds and brass.
Fees
Argyle Independent School District pays for much of the band’s annual costs. Some
costs need to be covered by the families.
Band fees cover the following expenses, plus more.
Uniform Parts:
● Personal marching shoes (White and Black)
● White and Black Socks
● Competition jacket or color guard uniform
● Gloves
● Compression Gear
● Show specific jacket
● Food for game days
● Food for competition days
● Snacks
● Special Summer Band masterclasses and clinicians
● Marching band trips.
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Instrument Rental
● Like middle school, there is a rental cost for all school-owned instruments and
percussion. This cost helps maintain your instrument from year to year.
UIL Fall Trips
● Costs for UIL trips, like the State Marching Contest, are covered by the
district.
Non-UIL Fall Trips
● The marching band occasionally travels to a non-UIL contest, like Bands of
America in San Antonio. The district does not cover this cost. We may
fundraise to help, but the marching band fee will not include the trip cost.
Marching Rehearsals
Why so many practices? Why do we start weeks before the opening day of school?
Marching a show is a performing art that requires and challenges students to work
together. The students move, march, dance, and play their instruments
simultaneously in coordination with their peers.
Marching band challenges students to work with each other. Each student is
dependent on their peers in these complex shows. Marching band takes a complex
musical and visual program; mastering it requires practice and hard work. Those
hours of training are essential to the band's success, and having everyone there for
every rehearsal is critical.
Like other sports and activities on campus, the band will learn most of the production
in the weeks leading up to the first day of school. During school, the band will learn
new material and master the learned material.
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Marching Band Participation
All students in the band program participate in the marching band. There are a few
options for how students can participate.
Varsity Marching Spot - Students have personal spots on the field, marching,
playing, and moving throughout the show. Varsity marching spots are by audition
only. Students will learn essential musical and visual skills for the audition. The front
ensemble does not have a marching responsibility; therefore, they will not have a
“marching audition.” All students in a Varsity Marching Band Spot must attend all
games, competitions, and marching band trips associated with the show. All varsity
marching band students can receive letter jackets, medals, and patches related to
the UIL and non-UIL competitions.
Varsity Stage Crew - Varsity Stage Crew members participate in the Varsity
Marching Band by assisting with the following: Building props, moving
props/equipment, running metronomes for rehearsal, organizing facilities, loading
trucks, unloading trucks, etc. All students in the Varsity Stage Crew must attend all
games, competitions, and marching band trips associated with the show. All varsity
marching band students can receive letter jackets, medals, and patches related to
the UIL and non-UIL competitions.
Non-Varsity/Athlete - Attends some rehearsals during the week but attends games,
practices, pep rallies, and other marching band performances when they do not conflict
with their sport. Only students participating in Football, Cross Country, Volleyball, and
Varsity Fall Tennis are eligible for Non-Varsity/Athlete. A Non-Varsity/Athlete may
assist with the Varsity/Stage Crew if the schedule doesn’t conflict. Non-Varsity/Athlete
students are not eligible for Varsity level awards associated with Marching Band,
including letter jacket qualifications. Non-Varsity athletes do not attend competitions.
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No Pass, No Play
Parents find it surprising the highest grades in their child’s year are typical during
marching season. Indeed, a child learns to manage their time wisely, and “No Pass,
No Play” has an effect.
If a student fails a non-AP or DC class, they will continue to practice but cannot
participate in competitions or play at football games for three weeks. If all of the
student's grades are passing by the Interim Progress Report (IPR) is issued, the
band member can return to full participation.
UIL requires an eligibility grade check following the first six weeks of school. This
grade check does affect eligibility.
Student Band Leaders
The Drum Majors: The drum majors direct the band during performances in the
stands and on the field and represent the band on the field during awards
presentations at competitions. All current 9th-11th graders can audition for drum
major.
Section Leader: A Section Representative’s responsibility is to organize the
section, help students with their music, and assist with the communication between
members and staff. A section representative may also host social events for their
section.
Woodwind and Brass Officers/Captains: These officers and captains
assist with organizing rehearsals, assisting students in music or marching, and
helping with communication between members and sections.
Band Council Officers: Through a peer review, the band will choose band
council positions in the Spring. These positions include but are not limited to
President, Vice President, and Secretary.
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Parental Role during Marching Band
Encourage your child: Sometimes, your child may be tired and even frustrated.
They may feel like, “I can’t do it.” They CAN do it. Encourage them to practice, seek
help, and stay positive. To be good at something requires patience, investment of
time, and practice.
Encourage perfect attendance: Everyone knows a team can only be a team when
everyone is present. Your child’s attendance helps the team and encourages a
robust positive bond and trust with their peers.
Work with other parents: If you are comfortable, work with other parents to get
your child to practice or plan meals. There are band students from every community
in Argyle. We understand that the band schedule might not work with the adult work
schedule at home.
Volunteer: By volunteering, you will meet your child’s friends and their families. YOU
ARE a part of the band program. There are many ways to volunteer. You can serve
food, chaperone a football game, build props, organize uniforms, and help raise
funds for financial aid.
Be at the performances: Your children work very hard!! They want to play and
perform for you more than anyone else.
One of the most uplifting aspects of attending competitions is how supportive most of
the other parents and fans of every band that competes are.
Your role is more than just to cheer on the Argyle Band (although you are
encouraged to do so loudly and enthusiastically!). When you are in the stands in
your Argyle attire, be encouraging to all band members at all schools.
Be a positive role model: All students admire and listen to you. They do appreciate
you! Be a positive role model and encourage your children, other students, and
parents to be positive and helpful.
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What You Need to Know About Competitions
● Take a hat and sunscreen (a fan is also very welcome)
● Buy patches. They are inexpensive and can be put on your child’s
letter jacket when they earn it or in a shadow box for display. It can be
impressive to have patches representing all the competitions in which
your child participated.
● Don’t buy the first recording offered at the first contest. Yes, it can be
exciting to see that performance repeatedly. However, some venues'
production values are not very good, and the band improves as the
season progresses. If available, purchase the last performance.
● Don’t record the show and post it on social media. Not only can the
recordings be against copyright laws, but we only want our absolute
best product to be in the public eye.
● When attending out-of-town contests, be prepared. Remember that
one day at an out-of-town competition can seem like a weekend
elsewhere.
Typical Contest Day Schedule
7:00 am - Arrive at the school
8:00 am - Run Through of production
9:00 am - Break and snack (Included in band fees)
10:00 am - Leave for the contest site
11:00 am - Unload at the contest site
Noon - Prelim Performance
12:30 - Change and eat lunch (Included in band fees)
Watch other groups and preliminary awards
7:00 pm - Finals performance
7:45 pm - Eat Dinner (Included in band fees)
9:00 pm - Watch other bands and finals awards
10:00 pm - Load and leave site
11:00 pm - Arrival at school
Midnight - Dismissal
Judging Criteria
What are the judges judging?
General Execution of the show: The judges look for straight lines, precise
movement of pictures, and precision of the music. Judges award students for the
accurate execution of challenging visual and musical elements.
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Individual Competitions
Region Band - In the fall
Your child will receive the audition music for the Region competition in December
from the Texas Music Educators Association (TMEA). The Varsity Wind Ensemble is
required to prepare and audition for the ensembles as a part of the curriculum. The
top-scoring students in the All-Region Band go on to compete at Area for inclusion in
the All-State Band.
UIL Ensemble Contest
Argyle ISD will compete in the UIL ensemble contest every February. Each band
student will be assigned to a small ensemble to perform at the competition. This
contest is open to the public, and we encourage each parent to attend the
performance.
Argyle Solo Contest
Argyle ISD holds solo and concerto contests every spring. Each student in the band
will be assigned a solo and required to perform their solo for a judge. Like the
ensemble contest, this contest is open to the public, and we encourage each parent
to attend the performance.
Private Lessons
Private lessons are strongly encouraged for all band students, as they provide
consistent one-on-one instruction, which is crucial in a student's development as
a young musician. Private lessons allow students to reinforce and receive
personal insight on the fundamentals that will help them succeed as musicians
and enable them to move at an accelerated pace beyond that of the regular band
class.
Private lessons also help our students to prepare for additional band events,
such as the Region/Area/All-State Band audition process, Solo and Ensemble
contests, chair tests, and different auditions. Private lessons ensure a solid
musical foundation for our students and encourage a diligent, progressive
approach to improving musicianship and organizational skills.
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Argyle Band 2025 Summer Band Camp
When: July 22nd-July 23rd (Freshmen and Leadership) ; July 28-August 16th
(All); August 16th (All)
Who: All 2025 AHS Band Participants.
Where: Argyle High School
Attire: Athletic shoes, shorts, comfortable t-shirt, hat, sunglasses, and
sunscreen
Bring Your instrument, a large water container (At least a gallon), and a
personal tuner if you own one. Students with school-owned instruments must
have their mouthpiece and neck strap. All wind players will need a flip folder
and lyre to perform music. Percussionists only need a flip folder.
Attendance
Attendance is essential for all Varsity Band members as we will learn most of
our marching production during this time. Junior Varsity Band members and
Stage will have a separate schedule announced closer to the camp. We do,
however, understand that emergencies happen. If there is one, please report
your attendance to the following staff members.
Brass/Woodwinds – evan.fletcher@argyleisd.com
Percussion – christine.mollenkopf@argyleisd.com
Color Guard – erica.king@argyleisd.com
Attendance for Summer Band
Below is the Summer Band Schedule. Though we don’t expect it to, the
schedule could change due to unforeseen weather conditions. We will always
use our email, Remind, and social media to communicate changes to the
schedule.
Important Communication Locations
For Remind, text the following codes to 81010
Woodwinds - @argyleww
Brass - @argylebr
Colorguard - @argylegd
Percussion - @argylepw
Website - www.argyleband.com
Facebook - Request membership to “Parents of The Argyle Band”
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Aug 16 Saturday 7:00 am-10:30 am Full Band Outside Marching
10:30 am-12:30 pm Lunch on your own
12:30 pm-4:00 pm Full Band Inside Music
4:00 pm Break
5:30 pm Students Eat
7:00 pm Performance
Cookout/
Parent Preview Performance
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February 24, 2025
Parents,
The following fees have been established for the upcoming 2025-2026 Marching Band
season.
Financial hardship should never be a barrier to band membership for your child. The
Argyle Band Boosters have endowed a scholarship fund to help defray some of these
costs for families exhibiting financial need. A Scholarship Committee comprised of Band
Directors, School Administrators and ISD representatives will confidentially review
applications and determine awards up to the endowed amount. Please contact Mr. Bird
to discuss scholarship grant opportunities and to complete the application forms.
The marching band fees collected are not sufficient to cover the total annual expenses of
our best-in-class band program. To bridge this deficit, the Argyle Band Boosters
conducts fundraising efforts throughout the year. The Argyle Band Boosters is a
registered 501 (c) (3) non-profit charitable organization. If you are looking to direct tax
deductible giving funds to our organization, where 100% of your donation is used to
benefit the children in the band programs, contact us at
Fundraising@ArgyleBandBoosters.com
It truly takes a village to support the efforts of our children throughout the year. To those
of you who helped at summer band, or built and moved props or percussion instruments,
served game-day meals, laundered, tailored and fit uniforms, transported instruments &
sets, raised or donated funds, volunteered your time at the concession stands or served
on the Board over the past year, please accept our most heartfelt thanks.
It is estimated that we will need 10,000 hours of volunteer assistance over the coming
year to support the band programs. If you are a returning parent volunteer, a Board
member will contact you over the coming months to again seek your help. If you are
new to the HS Band program or have not previously volunteered, we urgently request
your involvement. Please contact me at President@ArgyleBandBoosters.com and let me
know how you think your talents can be best utilized. Your children may not verbalize it
at the time but they like having you around and appreciate your efforts on their behalf.
We are impressed with the efforts that our children, the Band Directors and volunteers
expend over the course of the year and are excited to see the fruits of their labor over
the coming year.
We look forward to seeing you at the Show Reveal on March 6
th
.
Very Truly Yours,
Allison Jones
President – Argyle Band Booster Club
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2025-2026 Band Fees
Returning Member Marching Fee $900.00
Includes:
Summer Band Fee
Competition Fees
Competition Uniform
Compression Shirt
2 pairs of gloves
Black Socks
White Socks
Show Shirt
Uniform Maintenance Fees
Transportation to Games/Competitions
Game Day & Competition Meals
End of Year Banquet
Color Guard Fee $900.00
Includes:
Summer Color Guard Fee
Competition Fees
Competition Color Guard Uniform
Show Shirt
Transportation to Games/Competitions
Game Day & Competition Meals
End of Year Banquet
New Member Marching Fee: $1,100.00
All items included in Returning Member Fees plus:
Compression Shorts
Black Marching Shoes
White Marching Shoes
Backpack
Returning Members and Color Guard Members may pay their $900.00 fee in full or pay
as per the following installment schedule:
$200.00 on 3/15/25
$100.00 on 4/15/25
$100.00 on 5/15/25
$100.00 on 6/15/25
$100.00 on 7/15/25
$100.00 on 8/15/25
$100.00 on 9/15/25
$100.00 on 10/15/25
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New Marching Band Members may pay their $1,100.00 fee in full or pay as per the
following installment schedule:
$200.00 on 3/15/25
$150.00 on 4/15/25
$150.00 on 5/15/25
$150.00 on 6/15/25
$150.00 on 7/15/25
$150.00 on 8/15/25
$150.00 on 9/15/25
*Returning Marching Band Members are expected to utilize the compression shorts, and
black and white marching shoes that they have previously purchased. If these items
have been misplaced or no longer fit, Returning Marchers will need to purchase them in
the BoosterHub store.
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2025 MARCHING BAND COMMITMENT
CONTRACT
STUDENT NAME (please print first and last) ___________________________________
INSTRUMENT __________________________
As a member of the Argyle High School Band, you are required to adhere to all of the
organiza
on’s policies and procedures as outlined in the band handbook as well as those set
forth by Argyle ISD. Please read thoroughly and sign your ini
als on the line next to each
statement sta
ng that you understand each item.
Marching band is a co-curricular ac
vity. Par
cipa
on in the marching band requires all students to enroll in
the Instrumental Music class assigned by the director. Par
cipated students must commit to being on
me for
ALL rehearsals and performances. This will mean rearranging work schedules or other ac
vi
es. Parents must
ensure students are on
me for all rehearsals and performances.
____ ____ I have made the decision to be a member of the Argyle High School Band
Program and in the Varsity Marching Band specifically.
____ ____ By submi
ng this form, I realize that my par
cipa
on is expected in the
2025 marching band show.
____ ____ I understand that if I do not fulfill my obliga
on, I will cause hardship for those
members who remain in the program. My ac
ons could poten
ally have a
detrimental effect on the outcome of the 2025 Argyle Marching Band. This form
expresses my commitment to the organiza
on.
____ ____ I am aware of the
me commitment required. Furthermore, I understand the
importance of my a
endance at all rehearsals and performances.
____ ____ I will plan my schedule around planned rehearsals and performances.
____ ____ I understand that performances and rehearsals may be added to the schedule
throughout the year and the directors of the program will provide me with as
much no
ce as possible. I will make every effort to incorporate these added
items into my schedule.
____ ____ I will register and complete a marching band class for the fall semester and a
concert ensemble for the second semester of the 2025-2026 school year. Color Guard will
register and complete marching band class during the fall semester for the 2025-2026
school year.
____ ____ I am aware of the financial commitment that is involved. I understand the
importance of
mely payment of band fees and the need for help in fundraising
efforts.
____ ____ I understand that the $200 deposit and payments are non-refundable.
____ ____ I understand that I am responsible for the full payment 2025-2026 band fees
(NOT INCLUDING THE INSTRUMENT USE FEE IF APPLICABLE).
____ ____ I am dedicated to working with every member of the band and I will strive to
achieve Excellence in prepara
on, prac
ce, rehearsals, performance, and
academics.
____ ____ I understand that I must be pass all classes in order to be eligible to
par
cipate in any performances in accordance with the Texas No Pass, No Play
law, and I will make sure that I keep my grades up throughout the year.
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I understand the commitment that I am making to my fellow band students and the directors of Argyle High
School Band. I understand that this includes my responsibility to follow through, pass all of my classes,
prac
ce and learn my music, and be in a
endance for all rehearsals and performances. I will be proac
ve in
managing my
me and schedule so as not to conflict with band commitments.
STUDENT SIGNATURE:
______________________________________DATE________________
PARENT CONTRACT
I support my son or daughter's commitment to the Argyle High School Marching Band. I
understand that this includes a responsibility on my part to ensure that my son or daughter has
transporta
on to and from each rehearsal and performance. I will also ac
vely guide my son or daughter’s
me management to guarantee that this commitment is fulfilled.
PARENT SIGNATURE: _______________________________________
DATE________________
Suggested Fall SAT Dates: Suggested Fall ACT
Dates:
May 3, 2025 June 14, 2025
June 7, 2025 September 6, 2025
August 23, 2025 December 13, 2025
September 13, 2025 December 13, 2025
December 7, 2025
The band is an opportunity! The ac
ons of one individual cause
a ripple that affects every member of the band. Every move you
make; every ac
on you take, ma
ers.
Page 27 of 29
2025 Marching Band Participation
Student Name (Print)______________________________________________
Marching Instrument______________________________________________
Student Signature________________________________________________
Parent Signature__________________________________________________
The Argyle High School Marching Band comprises Varsity Marching, Stage
Crew, and JV/Athlete.
Check which participation level applies to your marching band participation.
______Varsity Marching – Attends all rehearsals, contests, and
performances. Must be able to play and march simultaneously with the
correct style and tempo. Participation is by audition only. Varsity/Marching
members rehearse 4-5 days per school week and attend all football
games, pep rallies, and competitions. Losing eligibility can affect status.
_______Varsity Stage Crew - Attends most rehearsals during the week.
Varsity Stage Crew members attend all games, pep rallies, and
competitions.
______Jr. Varsity/Athlete – Attends some rehearsals during the week but
attends games and other Marching Band performances when not
conflicting with their sport. Only Football, Cross Country, Volleyball, and
Varsity Tennis are eligible for JV/Athlete. A JV/athlete may be a stage crew
member if it does not conflict with their fall sport. JV/Athlete students are
not eligible for Varsity level awards associated with the Marching Band
(Ex. Letter Jacket).
______ JV/Medical - Participates in as many marching band activities as
permissible by a physician.
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PREPARTICIPATION PHYSICAL EVALUATION -- MEDICAL HISTORY 2020
This MEDICAL HISTORY FORM must be completed annually by parent (or guardian) and student in order for the student to participate in activities. These
questions are designed to determine if the student has developed any condition which would make it hazardous to participate in an event.
Student's Name: (print) Sex Age Date of Birth
Address Phone
Grade School
Personal Physician Phone
In case of emergency, contact:
Name Relationship Phone (H) (W)
If, in the judgment of any representative of the school, the above student should need immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and
consent to such care and treatment as may be given said student by any physician, athletic trainer, nurse or school representative. I do hereby agree to indemnify and save harmless the
school and any school or hospital representative from any claim by any person on account of such care and treatment of said student.
If, between this date and the beginning of participation, any illness or injury should occur that may limit this student's participation, I agree to notify the school authorities of such illness or
injury.
I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. Failure to provide truthful responses could
subject the student in question to penalties determined by the UIL
Student Signature: Parent/Guardian Signature: Date:
Any Yes answer to questions 1, 2, 3, 4, 5, or 6 requires further medical evaluation which may include a physical examination. Written clearance from a physician, physician
assistant, chiropractor, or nurse practitioner is required before any participation in UIL practices, games or matches. THIS FORM MUST BE ON FILE PRIOR TO
PARTICIPATION IN ANY PRACTICE, SCRIMMAGE, PERFORMANCE OR CONTEST BEFORE, DURING OR AFTER SCHOOL.
For School Use Only:
This Medical History Form was reviewed by: Printed Name Date Signature
1.
Yes
o
No
o 13.
Yes
o
No
o
2. o o o o
o o o o
3. o o 14. o o
o
o
o
o
o o 15. o
o
o
o
o o
o o o o
o o
o o
Have you ever gotten unexpectedly short of breath with
exercise?
Do you have asthma?
Do you have seasonal allergies that require medical treatment?
Do you use any special protective or corrective equipment or
devices that aren't usually used for your activity or position
(for example, knee brace, special neck roll, foot orthotics,
retainer on your teeth, hearing aid)?
Have you ever had a sprain, strain, or swelling after injury?
Have you broken or fractured any bones or dislocated any
joints?
Have you had any other problems with pain or swelling in
muscles, tendons, bones, or joints?
If yes, check appropriate box and explain below:
o o o Head o Elbow o Hip
o o
o Neck o Forearm o Thigh
o Back o Wrist o Knee
o Chest o Hand o Shin/Calf
o o o Shoulder o Finger o Ankle
o Upper Arm o Foot
o o 16.
17.
Do you want to weigh more or less than you do now?
Do you feel stressed out?
o
o
o
o
4.
4.
o o 18. Have you ever been diagnosed with or treated for sickle cell o o
o o trait or sickle cell disease?
Females Only
19. When was your first menstrual period? _____________
o o
o
o
o
o oo
When was your most recent menstrual period? _____________
How much time do you usually have from the start of one period to the start of
another? _____________
How many periods have you had in the last year? _____________
What was the longest time between periods in the last year? _____________
Have you had a medical illness or injury since your last check
up or physical?
Have you been hospitalized overnight in the past year?
Have you ever had surgery?
Have you ever had prior testing for the heart ordered by a
physician?
Have you ever passed out during or after exercise?
Have you ever had chest pain during or after exercise?
Do you get tired more quickly than your friends do during
exercise?
Have you ever had racing of your heart or skipped heartbeats?
Have you had high blood pressure or high cholesterol?
Have you ever been told you have a heart murmur?
Has any family member or relative died of heart problems or of
sudden unexplained death before age 50?
Has any family member been diagnosed with enlarged heart,
(dilated cardiomyopathy), hypertrophic cardiomyopathy, long
QT syndrome or other ion channelpathy (Brugada syndrome,
etc), Marfan's syndrome, or abnormal heart rhythm?
Have you had a severe viral infection (for example,
myocarditis or mononucleosis) within the last month?
Has a physician ever denied or restricted your participation in
activities for any heart problems?
Have you ever had a head injury or concussion?
Have you ever been knocked out, become unconscious, or lost
your memory?
If yes, how many times? __________
When was your last concussion? __________
How severe was each one? (Explain below)
Have you ever had a seizure?
Do you have frequent or severe headaches?
Have you ever had numbness or tingling in your arms, hands,
legs or feet?
Have you ever had a stinger, burner, or pinched nerve?
o o
5. Are you missing any paired organs? o o
6. Are you under a doctor’s care? o o
7. Are you currently taking any prescription or non-prescription
(over-the-counter) medication or pills or using an inhaler?
o o
8. Do you have any allergies (for example, to pollen, medicine,
food, or stinging insects)?
o o
9. Have you ever been dizzy during or after exercise? o o
10. Do you have any current skin problems (for example, itching,
rashes, acne, warts, fungus, or blisters)?
o o
11. Have you ever become ill from exercising in the heat? o o
12. Have you had any problems with your eyes or vision? o o
Explain “Yes” answers in the box below**. Circle questions you don’t know the answers to.
It is understood that even though protective equipment is worn by athletes, whenever needed, the possibility of an accident still remains. Neither the University Interscholastic League
nor the school assumes any responsibility in case an accident occurs.
Males Only
20.
21.
Are you missing a testicle? _____________
Do you have any testicular swelling or masses? _____________
EXPLAIN ‘YES’ ANSWERS IN THE BOX BELOW (attach another sheet if necessary):
An electrocardiogram (ECG) is not required. I have read and understand the
information about cardiac screening on the UIL Sudden Cardiac Arrest
Awareness Form. By checking this box, I choose to obtain an ECG for my
student for additional cardiac screening. I understand it is the responsibility of
my family to schedule and pay for such ECG.
Page 29 of 29
Lymph
Heart-Auscultation of the heart
the supine
Heart-Auscultation of the heart
the standing
Heart-Lower extremity
PREPARTICIPATION PHYSICAL EVALUATION -- PHYSICAL EXAMINATION
Student's Name _________________________________ Sex _______ Age _______ Date of Birth _________________________
Height ______ Weight________ % Body fat (optional) ________ Pulse __________ BP____/____ (____/____, ____/____)
brachial blood pressure while sitting
Vision: R 20/______ L 20/___ Corrected: o Y o N Pupils: o Equal o Unequal
As a minimum requirement, this Physical Examination Form must be completed prior to junior high participation and again
prior to first and third years of high school participation. It must be completed if there are yes answers to specific questions on
the student's MEDICAL HISTORY FORM on the reverse side. * Local district policy may require an annual physical exam.
NORMAL ABNORMAL FINDINGS INITIALS*
*station-based examination only
CLEARANCE
o Cleared
o Cleared after completing evaluation/rehabilitation for: __________________________________________________________
_________________________________________________________________________________________________________
o Not cleared for:_________________________________________Reason: _________________________________________
Recommendations: _________________________________________________________________________________________
_________________________________________________________________________________________________________
The following information must be filled in and signed by either a Physician, a Physician Assistant licensed by a State Board of
Physician Assistant Examiners, a Registered Nurse recognized as an Advanced Practice Nurse by the Board of Nurse Examiners,
or a Doctor of Chiropractic. Examination forms signed by any other health care practitioner, will not be accepted.
Name (print/type) __________________________________________ Date of Examination: ______________________________
Address: _______________________________________________________________________________________________________
PhoneNumber: ___________________________________________________________________________________________________
Signature: _____________________________________________________________________________________________
Must be completed before a student participates in any practice, before, during or after school, (both in-season and out-of-season) or performance/
games/matches.
Genitalia (males if indicated
Marfan's stigmata
pectus excavatum,
hypermobility,