A Note from the Nurse

~~~ A NOTE FROM THE NURSE ~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
PLEASE NOTE THAT THE NJ STATE DEPARTMENT OF EDUCATION
 FORMS
CAN BE FOUND UNDER "PRINTABLE FORMS".
 ONLY THESE FORMS WILL BE ACCEPTED.
PLEASE ALSO NOTE, THESE FORMS MUST BE COMPLETED IN FULL.
INCOMPLETE FORMS WILL BE RETURNED and
DELAY ATHLETIC CLEARANCE.
THANK YOU IN ADVANCE FOR YOUR COOPERATION.

The athletic season for the 2019 - 2020 school year
 
 
Physical Examination Form (Physician completes) and 
History Form (Parent/Guardian completes) 
need to be submitted to the School Nurse prior to dates below
and will be reviewed by our School Physician prior to athletic clearance.
 
 
Fall 2019 

ALL ATHLETIC PAPERWORK & FORMS ARE
DUE Monday, July 29th

Fall Season Begins on Monday, August 12th 

Please refer to the Athletic website for specific sport information
All  Fall Sports
Football, Boys Soccer, Girls Soccer, Boys & Girls Cross Country,
Volleyball, Girls Tennis, Gymnastics, Cheerleading 
Athletic paperwork will need to be submitted and approved by our School Physician prior to athletic clearance.
Forms will be reviewed by our School Physician prior to the
August 12th start date.
Any paperwork submitted after July 29th
may be subject to delay in participation.
Any incomplete forms will be returned, which will prolong your child's eligibility to participate.

PLEASE NOTE: The Physician who performs the physical must have completed the Student-Athlete Cardiac Screening PD module and sign the affirmation that it has been completed. 

All information must be provided (child's name/address; parent signature/date; physician signature/stamp/date of exam/eligibility to participate/specific limitations for participation).

ALSO, ALL PHYSICAL FINDINGS MUST BE DOCUMENTED: HEIGHT, WEIGHT, BLOOD PRESSURE, PULSE AND VISION.
Thank you in advance.
 
 
Physicals are valid for one year of exam date.  
Parental permission is valid (completely filled out, signed and dated) 
within 90 days of the beginning of each athletic season.  
Any parental permission forms received prior to this '90 day' will not be accepted.

What does this mean?  
Please submit all athletic forms -
physicals and health forms to my attention. 
Please bring to my attention any changes in your child's health, including injuries.  

If your child is an incoming freshman OR transferring into Pascack Hills -
A current physical and health history must be submitted to the School Nurse
prior to Physical Education Participation.


ALL NECESSARY FORMS CAN BE PRINTED FROM 
'PRINTABLE FORMS'

Thank you in advance.  
Rose T. Welyczko, BSN, RN, Certified School Nurse, MA
 
During summer months  ~~   I can be reached by email
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