Athletic Consent Form - Cedar Hill Prep School printable pdf download

Athletic Consent Form - Cedar Hill Prep School

CEDAR HILL PREP SCHOOL

152 Cedar Grove Lane, Somerset, NJ 08873

TEL

: 732-356-5400

FAX

: 732-356-5409

IMPORTANT INFORMATION FOR THE PHYSICIAN

COMPLETING THIS SPORTS PHYSICAL

The State of New Jersey now requires that all physicians, advanced practice nurses (APN), or physicians

assistants (PA) performing a sports physical examination, must complete the professional development

module (PD module) prior to performing any sports physicals.

In order to expedite the clearance procedure of this athletic physical, please be sure and sign the bottom of

the clearance form that you have completed the Cardiac Assessment Professional Development Module.

If your child’s doctor has not completed this assessment, the physical will not be accepted.

Registration for the fall athletic season will take place during the week of September 9th in the nurse’s

office. Please have your child stop in the nurse’s office for the appropriate forms. All forms can also be

downloaded from the school’s website under Athletics. If you have a physical scheduled before Sept 9th,

please contact the appropriate nurse for the forms needed. If your child’s physician has prescribed an

Epi Pen for your child’s allergy, you must submit a completed allergy action plan form with the sports

paperwork prior to the start of the sports season. Your child will not be allowed to participate if this form

is not completed by your physician and submitted to the health office.

MIDDLE SCHOOL FALL SPORTS

All forms are due by September 9th for the Fall Athletic Season. Please hand only fully completed

forms. All forms must be submitted directly to the nurse so they can be reviewed thoroughly before being

accepted as complete.

Any form handed in after September 9th may result in your child not being cleared in time for the first day

of practice. Our school physician has to review and sign all physical and history forms before the student

is “officially cleared.” Please keep this in mind and get your forms in ASAP. Your consideration in this

matter is greatly appreciated.

If you have any questions, please contact the Athletic Department and or the School Nurse.

Athletic Department:

William Rooney -

Courtney Tierney -

School Nurse:

Athletic Consent Form - Cedar Hill Prep School