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2019-2020 Sports Physicals Forms
Posted On:
Tuesday, February 04, 2020
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Dear Parent/Guardian: 

Sports physicals will be given on Friday, February 28, 2020 and Friday, March 6, 2020 between 8:00 AM and 12:00 PM. There is no charge for these physicals.  Prior to scheduling an appointment for a sports physical the parent and student must complete and sign the following forms:

Ø  Pre-participation Physical Evaluation History Form

   http://images.pcmac.org/Uploads/PaulsboroPublic/PaulsboroPublic/Sites/DocumentsCategories/Documents/athleticphysicalsform%20%281%29.pdf

Ø  Athletic Clearance Permission Form

Ø  Acknowledgment that you have read the Sports Related Concussion and Head Injury Fact Sheet

   https://www.state.nj.us/education/students/safety/behavior/athleteforms/Concussion%20Fact%20Sheet%20and%20Acknowledgemt%20Form.pdf

Ø  Acknowledgment that you have read the Sudden Cardiac Death Fact Sheet

  https://www.state.nj.us/education/students/safety/behavior/athleteforms/Sudden%20Cardiac%20Death%20in%20Young%20Athletes%20Pamphlet.pdf

  https://www.state.nj.us/education/students/safety/behavior/athleteforms/Sudden%20Cardiac%20Death%20Digital%20Sign-Off.pdf

Ø  Acknowledgement that you have read the Use and Misuse of Opioid Drugs Fact Sheet

  https://www.state.nj.us/education/students/safety/behavior/athleteforms/Opiod%20Use%20and%20Misuse%20Educational%20Fact%20Sheet.pdf

Ø  Consent to Random Testing for Banned Substances.

  https://www.njsiaa.org/sites/default/files/document/STEROID%20Consent%20Form%20REVISED.pdf

These forms must be submitted to the School Nurse by Tuesday, February 25, 2020 in order to schedule an appointment.

A physician of your choosing may also complete the sport physical.  In this case, you are responsible to pay for the examination.  In addition to the above forms, the physician must also complete:

Ø NJ State Approved Physical Examination form and NJ State Approved Clearance Form (https://www.state.nj.us/education/students/safety/health/records/athleticphysicalsform.pdf)

The school doctor must approval the examinations done by other physicians.  The school doctor will review these examinations on Friday, February 28 and Friday, March 6, 2020.  After March 6, 2020, physical examination forms will be reviewed by the school doctor once per week.  Student may not begin athletic participation until the school doctor gives his approval. 

If your child has asthma, you must provide an Asthma Action Plan (http://pacnj.org/wp-content/uploads/2016/02/Asthma-Treatment-Plan-STUDENT-MAY-2017.pdf).  If your child has a food allergy you must provide an Emergency Allergy Action Plan (file:///C:/Users/mporter/Downloads/Emergency-Care-Plan2019-eng.pdf) .  These plans must be signed by your physician.  Participation in school sports teams cannot begin until the signed Action Plans have been received by the school nurse.  These Action Plans are also required for school trips. 

Please be certain to submit all required documents as soon as possible so that participation is not delayed.  If you have any questions or if I can be of additional assistance, please contact me at your convenience.

Click ALL of the below documents to download the Sports Physical Forms 

#1. Physical Form 

#2. Health History Update Form 

#3. Asthma Action Plan Form

#4. Cardiac Sign Off Form  

Please complete ALL forms in their entirety and return to the Nurse's Office.  

 

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