If you are utilizing the Boosters convenience event on July 24, 2014 3:00 pm – 7:00 pm, Click here to follow these instructions, and Boosters will handle turning in all paperwork for you.  
For anyone NOT utilizing the Boosters Sports Clearance Medical Exam event on July 24, please follow these instructions: 


 – Please click HERE to and click on “Athletic Registration” to fill out District required Athletic Clearance forms

The website will direct you through the entire process.

  • You must print the Athletic Clearance Form. Note: This is the new version of the Athletic Clearance Form. Any older versions will not be accepted.
  • You must print one Online Registration Sports Summary page for each sport of participation.
  • Note: If this is the second or third sport, only the Online Registration Sports Summary Page must be submitted.


The Athletic Clearance Form will not be accepted without the following.

  • The date may not be hand written.
  • The health history checklist must be completed.
  • The physician must stamp and date.
  • The physician must sign and date. The date must be July 1, 2014 or later. The physician must be a licensed medical doctor. The physician may not be a chiropractor, acupuncturist, etc.


The Online Registration Sports Summary page will not be accepted without the following.

  • All emergency information.
  • Health insurance carrier and policy number.
  • Student and parent signature.

Each team will establish an amount for their team contribution and provide the budget that is used to establish the dollar amount. The contribution is not mandatory, but is necessary to provide our student-athletes with the best athletic experience.


The contribution may be paid on the Webstore. If paid by check, the check made payable to Acalanes High School may be submitted at the same time as the Athletic Clearance paperwork.


The Athletic Department strongly encourages purchase of a Booster Club membership. This financial support is important because the Booster Club is the sole financial sponsor of the Athletic Trainer’s stipend for Chris Clark as well as all of the supplies for the Athletic Training program. The district does not pay for any of these costs.


Athletic Clearances will be collected during residency verification in room 207.

  • Wednesday, August 6 through Friday, August 8 from 8:00 am to 3:30 pm.
  • Monday, August 11 through Friday, August 15 from 8:00 am to 3:30 pm.
  • Monday, August 18 from 8:00 am to 3:30 pm.


Athletic Clearances will be collected during Don’s Day Tuesday, August 19 in the small gym from 7:30 am to 3:30 pm.

Athletic Clearances will be collected during the following days and times in room 207 during the school year.

  • Monday, Tuesday, Thursday, and Friday, 7:30 to 7:50 am.
  • Monday through Friday at Brunch and Lunch.


If you are having difficulty getting the physician to sign the Athletic Clearance Form, you may contact the following medical providers for same day or next day appointments.


Dr. William Workman                                  Walnut Creek Urgent Care

Acalanes HS athletic team physician             112 La Casa Via Way, suite 135

301 Lennon Lane, Suite #100                       Walnut Creek, CA 94596

Walnut Creek, CA 94598                             Monday through Saturday

Mondays and Thursdays only                         $75

925-944-0110                                            925-930-8200


For questions or problem solving, contact Randy Takahashi by email at