SPORT PHYSICALS

Please click on this following link for the NJ Department of Education Athletic Pre-Participation Physical Evaluation Form.  The use of this form is required by N.J.A.C. 6A:16-Programs to Support Student Development.

Part A - Health History Questionnaire (3 pages) - must be completed by the parent and student and reviewed by the examining provider at the time of the Physical Examination.

Part B - Physical Evaluation Form (4 pages) - must be completed by the examining licensed provider (MD, DO, APN, or PA). Note that Part B , Page 3 requires the Physician's/Provider's Stamp.

Please be advised ALL INFORMATION AREAS must be completed including DATES and SIGNATURES.  If any area is left blank, the form is considered incomplete and will be returned to you.  At this point your child will NOT be permitted to participate in their sport.

All completed pages should be returned to the School Nurse.

Thank you.