Health Forms - Athletics

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 you child's School Nurse:

Name of Form

All Students

Specific Students

Health Examination Form


Completed by your own Healthcare Provider or School Healthcare Provider


Interval Athletic Health History


Completed and signed by your Parent/Guardian


Head Injury/Concussion Information Sheet (English/Spanish)



Read and signed by Student Athlete and Parent/Guardian


Medication Administration Form



Student requires medication during school, practice or events.

Medication Attestation Form for Independent Use



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