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    School Nurse, Christina Fanelli RN, BSN, NJ-CSN
    Tel. 201.664.0567 - Fax. 201.664.2715    

    Please remember that NO student is allowed to participate in official practice until forms are submitted and reviewed by our school physician for clearance. 

    All Students require the following forms:

    Click on the below forms to download and print 

    Health History Updated Questionnaire

    *All students must submit a New Health History Update Questionnaire that is completed and signed by parent/guardian within 90 days of the start of the season. 

    This is required for EACH sports season, regardless if you played in fall or winter. 

    PreParticipation Evaluation Form (Physical Form)

    This physical is valid for one full year from the date of the physical

    A new copy is not necessary if you already submitted to the health office and it is still valid

     

    PreParticipation Physical Evaluation Forms are to be completed, signed, stamped, and dated by the examining physician.

    The physician MUST sign off that he/she completed the cardiac assessment module.  

    This 4-page packet includes:

    • History Form   
    • The Athlete with Special Needs  
    • Physical Form 
    • Clearance Form  

    *Physical Exams are valid for ONE YEAR ONLY.  You may not participate with an expired physical.
     
    *Please be sure the physician signs, stamps and includes the date of physical, and checks off clearance status.
     
    ALL AREAS OF PHYSICAL MUST BE COMPLETED OR IT WILL BE RETURNED. This includes: Ht, Wt, Bp, VISION, Date of exam
     
    Your physician must sign the portion of the physical that states he/she has completed the cardiac module.
     
    The physical can not be accepted if your physician has not signed this or if he has not completed this module.
     
    **Please check this prior to your appointment**

    Checklist for Athletic Forms 

    Health History Update Questionnaire

    •    Required for ALL athletes and submitted prior to EACH SPORT SEASON
    •  SO if you play a fall, winter, and spring sport, you will be required to have  a new health history update prior to each season
    •  Completed by parent/guardian
    •  Must be signed and dated within 90 days prior to the official start of practice

     

    PreParticipation Physical Evaluation Forms

    • Required for ALL athletes; Physicals valid for ONE year only within 360 days of the first try out.
    • 4-page packet (all pages must be completed) includes:
    • History Form: (completed by parent)
    • All questions answered; signed by a parent
    • Athlete with Special Needs Form: (completed by Parent)
    • If not applicable, write N/A, and parent signs off
    • Physical Exam Form: (completed by MD)
    • Height, weight, Bp, and pulse
    • Date of exam

     

    VISION; if the examining doctor does not perform eye screening and you see an eye doc, you must supply proof of exam from your eye doctor.  The doctor completing the physical cannot just write “optho” in that section as this is not complete. If your pediatrician completes an eye screening and documents this, then you do not require an extra note from your eye doctor. 

    • Clearance checked, Signed, and dated by MD
    • Clearance Form: (completed by MD)
    • Clearance checked off   
    • Any allergies
    • Any other pertinent medical information 

    *MD must sign that he/she has completed the Cardiac Assessment Professional Development Module or physical can not be accepted. BE SURE TO CHECK THIS PRIOR TO APPOINTMENT.  NO PHYSICAL CAN BE ACCEPTED BY AN MD WHO HAS NOT COMPLETED THIS. 

    IMPORTANT INFO!!

    Only our school physician has the authority to review and medically clear athletes to participate in sports. What this means is that if you do not have your COMPLETED paperwork submitted by the due date on the ATHLETICS webpage,  you run the real risk of not being able to participate in tryouts on the first day of the season.  Please see the athletic web page for the first day of the practice schedule.  

    The school doctor will be reviewing each and every individual student's paperwork who intends on going out for a Spring sport. You will not be able to hand your paperwork into the nurse's office and practice that afternoon. It could be a week or more before you are cleared, depending on when the school doctor is scheduled to come to review these documents.