The following forms must be filled out, signed and returned to Catherine Lewis prior to the first day of practice for any sport.

1. Pre-participation Physical Evaluation Forms

You can substitute a form from your own physician but it must clearly state that the athlete has been cleared for all activities.

The pre-participation physical evaluation must be completed after May 1st, 2025.

• Pre-participation Physical Evaluation Forms

2. Duchesne Athlete and Parent Contract

The form includes participation consent, athletic handbook acknowledgment, and concussion protocol acknowledgment. For your convenience, you are able to submit this form electronically by downloading, saving to desktop, and hitting the submit button on the bottom of page 2. The pre-participation physical evaluation form and other necessary forms must still be submitted to Catherine Lewis.

Required Health Forms

Here you will find a folder with specific health conditions noted. Please open that folder and complete all forms within that folder. Please send Required Health Forms to school nurse, Grace Benson, BSN, RN, at gbenson@duchesneacademy.org. If you have questions or feel your child’s emergency action plan requires adaptation, please email Grace Benson.

• The “update” form in each health condition folder must be completed annually to gain the most current and accurate information regarding your child’s health needs. Your cooperation is very important. The completed “update” provides student-specific information to guide Duchesne personnel in case your child experience difficulties related to their medical condition at school or during Duchesne activities. Parents/guardians should complete the update form and have it signed by your child’s physician. Thank you for returning the following “update” forms to school promptly.
• The “Emergency Action Plan” in each folder is a reference as it will be followed if your child experiences difficulties related to their medical condition at Duchesne.
• The “Medical Authorization” form is for any medication, prescription or over the counter, that needs to be filled out if this medication is taken by the student during school or school activities.
• The “DHHS health release” forms are state-mandated forms for the student’s self-management of various health conditions at school.
• If you reside out of the state of Nebraska, you need to complete the vision and physical form for your daughter per state regulations. The school needs verification of a physical and a vision exam if you live out of state, but will take any physical or vision form provided by your physician.