Health Forms
Allergy Action Plan - Food and Non-Food - and Waivers of Liability
This form provides important allergy information to school medical personnel so that an appropriate individualized health care plan is in place during the time the affected student is in the school environment.
This form provides important asthma treatment information to school medical personnel so that an appropriate individualized health care plan is in place during the time the affected student is in the school environment.
This handout is published by the New Jersey Department of Education and provides information regarding head injuries and concussions. The handout also includes signs and symptoms of concussions.
This form provides important diabetes management information to school medical personnel so that an appropriate individualized health care plan is in place during the time the affected student is in the school environment.
Health Immunization Requirements for Sixth Graders/11-Year-Olds
The NJ Department of Health and Senior Services requires parents/guardians to provide updated immunizations records for their child prior to the child entering sixth grade or reaching 11 years of age.
Informational pamphlet prepared by the New Jersey Department of Education on how a parent can limit a child's exposure to violence on televisions, cell phones, computers, and other electronic devices, on an annual basis pursuant to N.J.S.A. 18:A:40-44.
The Opioid Fact sheet is co-authored by the New Jersey Department of Health, the New Jersey Department of Education, and the NJSIAA Sports Advisory Committee. This is a resource intended to assist parents in opioid use and misuse with suggestions on how to keep student athletes safe from injury.
Peanut/Nut-Free Table & Release and Hold Harmless Agreement
It is the district's practice that students with peanut/nut allergies are seated at a "peanut/nut-free" table during lunch. Parents/guardians wishing their child to be seated at a regular table must complete requirements outlined in this document.
Permission to Administer Medication During School
This form grants permission to the appropriate school personnel to administer medication to a student during school hours.
Permission for Self-Administration of Epi-Pen and/or Inhaler and Waiver of Liability
This form allows parents/guardians to grant permission for their child to self-administer an epi-pen or inhaler during the school day.
Permission for Designee to Administer Epi-Pen and Waiver of Liability
This form allows parents/guardians to grant permission for a designee to administer an epi-pen to their child during the school day.
Routine Physical for Fourth and Seventh Graders
Although not required, the district recommends that a child have a physical exam in fourth and seventh grades.
Seizure Action Plan
Questionnaire for Parent of a Student with Seizures and Seizure Action Plan
The forms above provides important seizure treatment information to school medical personnel so that an appropriate individualized health care plan is in place during the time the affected student is in the school environment.
Sudden Cardiac Death Brochure
This brochure, published by the American Heart Association, contains important information about sudden cardiac death in young athletes.
FOR MIDDLE STUDENTS ONLY
Please carefully read, sign, and print the complete packet of athletics information, which consists of the Sports Physical Exam Form, the Sports Repeater Form, the Sports-Related Concussion and Head Injury Fact Sheet and Parent/Guardian Form/Sign Off, Opioid Use and Misuse Educational Fact Sheet/Sign Off, and Sudden Cardiac Death in Young Athletes/Sign Off.
Memorial Athletics Information
This includes the Sports Physical Exam Form, the Sports Repeater Form, the Sports-Related Concussion and Head Injury Fact Sheet and Parent/Guardian Form/Sign Off, Opioid Use and Misuse Educational Fact Sheet/Sign Off, and Sudden Cardiac Death in Young Athletes/Sign Off.
(Health History Update Questionnaire)
Consent for School Physician to Conduct Sports Physical Exam
Sports physicals for seventh and eighth graders, as well as for incoming sixth graders, must be conducted by the student’s personal medical doctor/medical facility. The only exception is for parents of those students who have qualified for free or reduced lunch. Your children may be eligible for a sports physical to be performed at school. Please contact your middle school’s nurse for further instructions before completing this form.