P It PHYSICIAK S ADDRESS DATE 74% TELEPHONE NO. PBSO 1482 (NEW 8193) GC6684a EFTA01709625 SL .d0L BOARD OF PALM BEACH COUNTY, FL ADA SCHOOL ATHLETIC HEALTH EXAMINATION FORM-(PRE-PARTICIPATION) THIS FORM MUST BE FILLED OUT COMPLETELY BEFORE STUDENT IS ALLOWED TO PRACTICE AND OR COMPETE STUDENTS NAM SC