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 tryouts or participation in any sport.

Complete and return the following forms to you child's School Nurse:

Name of Form

Health Examination Form

Interval Athletic Health History

Head Injury/Concussion Information Sheet (English/Spanish)

Medication Administration Form

Medication Attestation Form for Independent Use

All Students

X

Completed by your own Healthcare Provider or School Healthcare Provider

X

Completed and signed by your Parent/Guardian

X

Read and signed by Student Athlete and Parent/Guardian

Specific Students

X

Student requires medication during school, practice or events.

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