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  • Please return all Medical forms to the Main Office or the Medical Office:  “Attn School Nurse”

    Freshman and Transfer students:  A history and physical must be presented before the first day of school.  The health history questionnaire is to be completed by the parent/guardian and reviewed by the physician at the time of the physical.   Please ask your physician to attach a copy of your student’s immunization record. Please ask your physician to complete any medication forms that are applicable to your child.

    Forms:

    • Preparticipation Physical Evaluation History Form
    • Preparticipation Physical Evaluation Examination Form and Clearance Form
    • Attached Immunization Record-immunizations are required by the State of New Jersey for all students. Students are subject to exclusion if this information is not on file in the medical office.

    All medication must have a medical prescription and parental request.It must be in the original container and clearly labeled.

    Forms:

    • Request for medication to be administered by the School Nurse
    • Asthma Action Plan- available for download from the school website must be completed if your student has asthma documented on the history and physical, and/or your student carries an inhaler.
    • Life Threatening Allergies Health Care Plan-available for download from the school website must be completed if your student has a documented life threatening allergy and/or carries an EpiPen.
    • Diabetes Medical Management Plan-available for download from the school website must be completed if your student has a documented diagnosis of diabetes.

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    Students participating in sports:

    An annual physical is required for any student participating in sports.  Physicals are good for one calendar year.  A new physical must be completed every 365 days. Any athlete that uses an inhaler or an EpiPen MUST have a healthcare plan.

    Forms:

    • Preparticipation History and Examination and Clearance Form
    • NJIAA Steroid Testing Policy-Consent to random testing
    • NJSIAA Parent/Guardian Concussion Policy Acknowledgement Form
    • NJSIAA Parent/Guardian Sudden Cardiac Death Acknowledgment
    • Holy Cross Academy Athletic Participation Form
    • 2 Emergency Information Cards - All forms are available in the Main Office

    Please make certain that all forms are signed by both the parent/guardian and the student as indicated. Make sure the Physical Evaluation form is completely filled out, signed and stamped by the examining physician.  Incomplete forms will be returned and will delay your student’s participation in sports.

    If your athlete participates in more than one sport, the following forms must be resubmitted for each sport:

    • Preparticipation History Form Only
    • 2 Emergency Cards
    • Holy Cross Academy Athletic Participation Form

    Links to all .PDF files are below:

    Athletic Participation Form

    Preparticipation History & Physical Form

    NJSIAA Steroid Testing Consent Form

    Steroid Testing Protocols for 2016-2017

    NJSIAA Concussion Policy

    Asthma Treatment Plan - Fillable

    Food Allergy & Emergency Care Plan

    Authorization for Medication to be Given During School Hours

    Sudden Cardiac Death Flyer

    Emergency Information Cards - Please Complete Two

     

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