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 2018 - 2019 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 

FOOTBALL PAPERWORK & FORMS ARE
DUE MONDAY, JULY 23 
~ SEASON BEGINS THURSDAY, AUGUST 9 

ALL FALL ATHLETICS PAPERWORK & FORMS ARE
DUE MONDAY, JULY 30
~ SEASON BEGINS MONDAY, AUGUST 13

Please refer to the Athletic website for specific sport information
All  Fall Sports
Fall Cheerleading ~ Cross Country ~ Football ~ Gymnastics
Boys Soccer ~ Girls Soccer ~ Girls Tennis ~ Volleyball
PVRHS Teams: Dance 

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 9th / August 13 start dates.
Any paperwork submitted after July 30
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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