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 Young Champions Heart Screening Registration  Young Champions Heart Screening Registration

"Young Champions" Heart Screening Registration

PeaceHealth Southwest Medical Center and the Quinn Driscoll Foundation are proud to offer "Young Champions," a program providing advanced heart screenings for student athletes in Clark County.

Any Clark County middle or high school athlete, band member or cheerleader from 13 – 18 years old is eligible for a "Young Champions" screening. Although designed for the student athlete, this screening event also accommodates all children in the age group who may be at risk (family history).

Registration is now open for the Young Champions Screening Event on Saturday, February 25 at PeaceHealth Southwest Medical Center. Register online (see form below) or call 360.514.7755 to sign up. Weekly screenings are also available at PeaceHealth Southwest for $50, which include a $25 donation to support future screening events in our community.

Students must have a completed parent consent form and health history questionnaire to participate. You may download these documents, or call for a mailed copy. Download "Young Champions" Consent Form (required) Download "Young Champions" Health History Questionnaire(required)
* Indicates required information
Student First Name * 
Student Last Name * 
Student Date of Birth    (mm/dd/yyyy)
Student Gender 
School Name/Type of Sport 
Parent/Legal Guardian First Name * 
Parent/Legal Guardian Last Name * 
Street Address 1 * 
Street Address 2 
City * 
State * 
Zip * 
Email Address (not required, but recommended for a quicker response) 
Telephone Number * 
 




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