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Physical/Permission Forms

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Medical Requirements for Sport Participation 2011-12
 If a student intends to play sports for the Kirkwood Pioneers, he/she must have a current (after February 1, 2011) physical form filled out and signed by a doctor and a permission form signed by a parent/guardian on file in the athletic office. These forms must be turned in together to the KHS Athletic Office by the first day of team practice.

Additionally, every student must have basic accident/medical insurance coverage to participate in athletics. This information is to be provided on the permission form and must include company name and policy number. If you do not have medical coverage, see below for options.

FORMS

ATHLETE PHYSICAL/PERMISSION FORMS 2011-12

KHS CODE OF CONDUCT

Click here to view the 2010-11 Student/Parent Athletic Handbook online. (Will be updated for 2011-12 when school is out for the summer.)


BASIC ACCIDENT/MEDICAL INSURANCE OPTIONS

  • MEDICAID: Government provided coverage that has specific eligibility requirements. Contact your local family support division office, the regional office at 314-877-4000 or visit  http://www.dss.mo.gov/mhd/index.htm  for more information and to apply. [Application process can take up to 30 days.]
  • MARKEL: Voluntary accident insurance with several package options. Click here (pdf, 242.14KB) to save and print the forms. [Insurance instated upon received payment. Purchased by the individual.]
  • ANTHEM BLUE CROSS BLUE SHIELD: Monthly medical insurance with several coverage options. Visit  http://www.anthemdirectmo.com/244EPLL  to view/select plan and apply. [Two week application process. Purchased by the individual.]

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