Southern Regional School District: Board Office - Building Access

Athletic Physical Appointment Request Form

Please fill out this form to schedule an appointment for an Athletic Physical.

Athletic Physical information for the 2020-2021 school year

Athletic physicals with Southern’s physician, Dr. Todd Schmoll, will take place in the 11/12 nurses office on the following days between the hours of 11 a.m. and 3:30 p.m.

Tuesday, July 21 – High School students (9th thru 12th grade students)
Tuesday, July 28 – High School students (9th thru 12th grade students)
Tuesday, August 4 – Middle School students (7th and 8th grade students)
Tuesday, August 11 – Middle School students (7th and 8th grade students)
Tuesday, August 18 – High School students (9th thru 12th grade students)

* Required Field

*Student First Name

*Student Last Name

* Student Cell Phone

* Parent Cell Phone

*Student Email Address

*Confirm Student Email Address

*Parent Email Address

*Confirm Parent Email Address

* Select Appointment Date

Board Of Education

Athletic Physical Appointment Request Form