Physical Examination and Health Information Forms

Health Examination Forms

Saint Peter's Prep requires an updated immunization record and an annual physical of all students.  The physical must be performed by an M.D., D.O. or nurse practitioner by the dates indicated in the letter sent by the Principal in June.  

Click here to view the letter regarding health examination forms sent by email to all parents and students in June 2015

 

All questions about health records should be directed to the school nurse, Ms. Maureen Sheppard, R.N., at sheppardm@spprep.org or 201-547-6406.  Athetes should contact the athletic trainer, Mr. Kyle Kutsup, at kutsupk@spprep.org or 201-547-2306.

The required immunization and health examination forms, as well as any optional forms, may be accessed below.

 

Required of ALL students (click below to download)

Physical Examination Form

Immunization Record

Pamphlet "Sudden Cardiac Arrest in Young Athletes"

Parent Sign-off Sheet on "Sudden Cardiac Death"

 

Optional Forms (click below to download)

Request for Medication to be Administered by the School Nurse Form

Request for Self-Administration of Medication Form

Asthma Treatment Plan Form

Diabetic Medical Management Plan Form

Authorizatuion for Glucagon Administrationby Non-School Nurse Personnel form

Severe Allergic Reaction Form (Epi-pen)

 

Required Student-Athlete Forms (click below to download)

Every student athlete must have the following forms completed and on file for each sport they participate in.

  1. Parent Permission Form Link
  2. Parent Transportation Release Form
  3. NJSIAA Concussion Consent Form
  4. NJSIAA Steroid Policy Consent Form

All questions about health records should be directed to the school nurse, Ms. Maureen Sheppard, R.N., at sheppardm@spprep.org or 201-547-6406.

All questions about required student-athlete forms should be directed to the athletic trainer, Mr. Kyle Kutsup at kutsupk@spprep.org or 201-547-2306.

Saint Peter's Prep • New Jersey's Jesuit High School since 1872
144 Grand Street • Jersey City, NJ 07302
P: (201) 547-6400 • F: (201) 547-2341
Site created by Hopeworks 'N Camden