CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
PHYSICAL EXAMINATION CHECKLIST
Instructions: All documents are required to be completed online prior to the sport's
scheduled physical examination date. Hand written documents are not accepted. Student-athletes
must print the documents completed online. All printed documents must have the student-athlete
signatures and/or initials as indicated on each document. Signatures and initials must be
completed in black ink. Athletes Under the Age of 18 Require Parent/Guardian Signatures.
- New Student-Athlete History OR Returning Student-Athlete Questionnaire (All Student-Athletes
must see the team physician on the day of the physical to receive clearance)
- Emergency Informatin Card
- Statement of Beneficiary
- Authorization Waiver
- Proof of Insurance
- ADD/ADHD Disclosure
- Sickle-Cell Trait Disclosure
***STUDENT-ATHLETES MISSING ANY PORTION OF THE ABOVE LIST WILL BE FORCED TO THE BACK OF THE LINE