Academy of Saint Elizabeth

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Athletics » Athletic Forms

Athletic Forms

Student athletes are required to submit a physical form, a permission form and an athlete contract  annually.  (click on link below to download all forms)

PARENTS OF STUDENT ATHLETES:

Please review the following guidance and direction for use of the new health form materials.

Click on the links to download all required forms.

Pre-participation Physical Evaluation (PPE)                                                                                                               
This form must be used for all student physical examinations prior to participation in school-sponsored interscholastic and intramural sports from this point forward.

The PPE includes a History Form to be completed by the parent or guardian; a Supplemental History Form for Students with Special Needs; a Physical Examination Form and a Clearance Form to be completed by the examining physician, advanced practice nurse (APN) or physician assistant (PA).

According to N.J.A.C. 6A:16-2.2(h)1ii(4), an incomplete form shall be returned to the student’s medical home for completion unless the missing information is available from health screenings completed by the school nurse or physician within the prior 365 days.
1.The PPE is available at:
 
Health History Update Questionnaire                                                                                                                      
The parent or guardian of each student-athlete must complete and sign an updated health history questionnaire if the pre-participation physical examination was conducted 90 or more days prior to the first practice session of the athletic season. The health history update questionnaire addresses the specific questions recommended by the American Heart Association. The questionnaire must be completed and signed by the student’s parent or guardian and submitted to the school nurse.

 2. Health History Update Questionnaire may be found below
Sudden Cardiac Death In Young Athletes Pamphlet                                                                                         
 
Pursuant to N.J.S.A. 18A:40-41(d), school districts must distribute the Sudden Cardiac Death In Young Athletes pamphlet to each student-athlete and to the parents or guardians of the student-athletes, as part of the student’s pre-participation physical examination and completion of the athletic permission forms. A student-athlete and the parent or guardian of the student-athlete shall certify in writing that they received and reviewed the pamphlet.

3.The pamphlet can be found below