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 between the dates of June 15 and August 31, 2013.  The completed forms must be submitted to the school nurse, Ms. Maureen Sheppard, R.N.  Please be sure to retain a copy of all forms in case they are lost.  Please clearly mark the envelope "Health Records" and address it to Ms. Sheppard here at Prep or drop it off at the reception area during the summer.   
 
All fall athletes must submit their physicals by August 1, 2013. 
 
At the very latest, students may bring their completed health forms to student orientation in late August/early September.  Any student without a properly completed health record will not be allowed to attend classes until the form is submitted.
 
All questions about health records should be directed to the school nurse, Ms. Maureen Sheppard, R.N., at sheppardm@spprep.org or 201-547-6406The required immunization and health examination forms may be accessed below.
 
Required of ALL students (click below to download)
Physical Examination Form
Immunization Record
 
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
Severe Allergic Reaction Form (Epi-pen)
 
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.

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
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