FREE SPORTS PHYSICAL EXAMS ON NOVEMBER 6, 2020
Dear Parent/Guardian:
CLICK HERE FOR THE PHYSICAL PACKET INFORMATION
CLICK HERE TO SIGN UP FOR 2020-2021 SPORTS
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 October 30th, 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)
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.