HEALTH & WELLNESS:

PRE-PARTICIPATION PHYSICAL EXAMINATION

Give this cover letter and the following form to your Physician,
Physician Assistant, or Nurse Practitioner.

Dear Healthcare Provider,

Please complete the attached Pre-participation Physical Examination Form requested by your patient to
participate in the Blue Devils Drum & Bugle Corps.

WHAT YOU NEED TO KNOW

Drum corps is an extremely physical activity involving a summer tour which includes:
• Physical training similar to marathon training
• Lower extremity demands similar to basketball or soccer
• Carrying instruments up to 50lbs, while marching/jazz running >200 steps/minute
• Extreme heat: ground temperature can exceed 160° F (i.e. synthetic turf)
• Practicing 12-14 hours/day, outdoors
• Dance requirements similar to a professional dance company
• Dancing/Marching on a variety of surfaces including grass, dirt, asphalt
• Caloric demands >6000 kcal/day
• Running/Marching >6 miles/day, 7 days/week, x 3 months
• Sleeping on only gym floors and buses for 3 months
• Highly repetitive activities => risk of overuse and repetitive strain injuries

RECOMMENDATIONS

• Complete Medical exam

• Complete Musculoskeletal exam
• Hearing / Vision exam
• Address Mental Health Issues; including anxiety/depression
Please arrange for patient to have a three-month supply of all medications, including mental health
medications, to last the entire tour (mid-May to mid-August) or assist the patient with arranging to have
medications mailed to him/her while traveling.

Questions/concerns, please contact:

Debbie Seeley, DPT

Health & Wellness, BD Performing Arts
dseeley@bluedevils.org
925.876.1108

letter and the following form to your Physician,

2018-09-18 1
 HEALTH & WELLNESS PROGRAM:
PRE-PARTICIPATION PHYSICAL EXAMINATION

This form is to be completed by a Physician, Physician Assistant, or Nurse Practitioner.

Participant’s Name Birthdate

Sex M F Height Weight BMI

Pulse BP Vision R: 20/ L: 20/ Corrected: Y N

MEDICAL NORMAL ABNORMAL FINDINGS

Appearance
Eyes/Ears/Nose/Throat
Lymph Nodes
Heart
Pulses
Lungs
Abdomen
Genitourinary (males only)
Skin

MUSCULOSKELETAL NORMAL ABNORMAL FINDINGS

Neck
Back
Shoulder/Arm
Elbow/Forearm
Wrist/Hand
Hip/Thigh
Knee
Leg/Ankle
Feet
Please attach immunization records, including dates given, on separate paper.

CLEARANCE STATUS

Cleared for participation without restriction

Cleared, with recommendation for further evaluation or treatment for

Not cleared, due to

Provider’s Name Phone #

Address License #

Provider’s Signature Date

Provider stamp: