Health Forms - Athletic Sports Programs

City School District of New Rochelle's Athletics Program requires students to be medically cleared by their School Health Office prior to try-outs or participation in any sport.

Complete and return the following forms to the School Nurse:

NAME OF FORM ALL STUDENTS SPECIFIC STUDENTS
Health Examination Form

X

Completed by your own healthcare provider or school healthcare provider, once, annually

 
Annual Athletic Health History

X

Completed and signed by your parent / guardian, once, annually

 

Interval Athletic Health History

X

Completed and signed by your parent / guardian, for each additional sports season

 
Medication Administration Form  

X

Student requires medication during school, practice or events

Medication Attestation Form for Independent Use  

X

Student requires medication AND can self-carry and self-administer medication

To best ensure the health and safety of your student athlete during each athletic season, please alert the Health Office immediately, if your child:
1. Sustained an injury requiring medical treatment
2. Is hospitalized
3. Requires surgery
4. Is diagnosed with a serious illness
5. Missed school for greater than 5 days

For information regarding the Health Services requirements, please call:
• NRHS Health Office: 914-576-4575
• ALMS Health Office: 914-576-4331
• IEYMS Health Office: 914-576-4368

For information regarding the Athletics Program, please call:
Athletic Department: 914-576-4586