• South Prairie Student Athlete Sports Physical Registration

    Sports physicals provided by Minot Health Clinic on July 30, 2026, at South Prairie School, from 8:00 AM–12:00 PM. Cost is $50 and is due at registration. Please select an appointment time below and complete the NDSAA History Form. You do NOT need to bring a hard copy of the sports physical paperwork to your appointment.
  • Appointment*
  • Format: (000) 000-0000.

  • NDHSAA PREPARTICIPATION PHYSICAL EVALUATION

    HISTORY FORM
  • Date of birth:*
     - -
  • Date of examination (Please Enter 07/30/2026)*
     - -
  • Rows

  • GENERAL QUESTIONS
    Explain "Yes" answers at the end of this form.

  • 1. Do you have any concerns that you would like to discuss with your provider?*
  • 2. Has a provider ever denied or restricted your participation in sports for any reason?*
  • 3. Do you have any ongoing medical issues or recent illness?*

  • HEART HEALTH QUESTIONS ABOUT YOU

  • 4. Have you ever passed out or nearly passed out during or after exercise?*
  • 5. Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?*
  • 6. Does your heart ever race, flutter in your chest, or skip beats (irregular beats) during exercise?*
  • 7. Has a doctor ever told you that you have any heart problems?*
  • 8. Has a doctor ever requested a test for your heart? For example, electrocardiography (ECG) or echocardiography.*
  • 9. Do you get light-headed or feel shorter of breath than your friends during exercise?*
  • 10. Have you ever had a seizure?*

  • HEART HEALTH QUESTIONS ABOUT YOUR FAMILY

  • 11. Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 35 years (including drowning or unexplained car crash)?*
  • 12. Does anyone in your family have a genetic heart problem such as hypertrophic cardiomyopathy (HCM), Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC), long QT syndrome (LQTS), short QT syndrome (SQTS), Brugada syndrome, or catecholaminergic poly- morphic ventricular tachycardia (CPVT)?*
  • 13. Has anyone in your family had a pacemaker or an implanted defibrillator before age 35?*

  • BONE AND JOINT QUESTIONS

  • 14. Have you ever had a stress fracture or an injury to a bone, muscle, ligament, joint, or tendon that caused you to miss a practice or game?*
  • 15. Do you have a bone, muscle, ligament, or joint injury that bothers you?*

  • MEDICAL QUESTIONS

  • 16. Do you cough, wheeze, or have difficulty breathing during or after exercise?*
  • 17. Are you missing a kidney, an eye, a testicle (males), your spleen, or any other organ?*
  • 18. Do you have groin or testicle pain or a painful bulge or hernia in the groin area?*
  • 19. Do you have any recurring skin rashes or rashes that come and go, including herpes or methicillin-resistant Staphylococcus aureus (MRSA)?*
  • 20. Have you had a concussion or head injury that caused confusion, a prolonged headache, or memory problems?*
  • 21. Have you ever had numbness, had tingling, had weakness in your arms or legs, or been unable to move your arms or legs after being hit or falling?*
  • 22. Have you ever become ill while exercising in the heat?*
  • 23. Do you or does someone in your family have sickle cell trait or disease?*
  • 24. Have you ever had, or do you have any problems with your eyes or vision?*
  • 25. Do you worry about your weight?*
  • 26. Are you trying to or has anyone recommended that you gain or lose weight?*
  • 27. Are you on a special diet or do you avoid certain types of foods or food groups?*
  • 28. Have you ever had an eating disorder?*

  • FEMALES ONLY

  • 29. Have you ever had a menstrual period?
  • I hereby state that, to the best of my knowledge, my answers to the questions on this form are complete and correct.
  • Date:*
     - -
  • Date of birth:
     - -
  • Date of birth:
     - -

  • SHARED EMERGENCY INFORMATION

  • PERMISSION FOR MEDICAL TREATMENT

    In the event of an emergency requiring medical attention, I hereby grant permission for emergency treatment for my daughter/son. I expect an effort will be made to contact me if an emergency occurs. I understand the cost for any medical attention may not be covered or paid by any high school or the North Dakota High School Activities Association. I hereby approve participation in athletic activities.
  • Date*
     - -

  • Refund Policy:

    Please note all approved refunds will be in the amount of $48.25.

  • My Products*

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      Sports Physical
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