Approximately 30 million athletes younger than 18 years and another 3 million athletes with special needs receive medical clearance to participate in sports every year. The purpose of the preparticipation physical evaluation (PPE) is to maximize the health of athletes and their safe participation in sports. The most comprehensive guideline on the PPE is the 4th edition of the American Academy of Pediatrics' PPE recommendations, which contains consensus recommendations and has been endorsed by multiple stakeholder medical societies. Although studies have not found that the PPE prevents morbidity and mortality associated with sports participation, it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries. Clinical Recommendations 1) Preparticipation physical evaluations should occur approximately six weeks before activity to allow for further evaluation, treatment, or rehabilitation as needed. 2) All persons undergoing preparticipation physical evaluations should be questioned about exertional symptoms, the presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death. 3) Athletes with sustained systolic blood pressure of less than 160 mm Hg and diastolic blood pressure of less than 100 mm Hg should not be restricted from playing sports. 4) Athletes with well-controlled asthma who are asymptomatic at rest and with exertion can be safely cleared to play sports. 5) Screening blood and urine tests are not recommended for asymptomatic athletes.