Sport Physical Info & Forms (Multiple PDF Links on Page)

UPDATE:
 
Please note that we are moving to an online solution (FinalForms) to simplify and reduce the number of times you will need to fill out paperwork and to provide an increased level of service for our students.  Please see your email accounts for an email from FinalForms from July 11, 2018.
 
The Physical and Health History forms are still available below as its a state issued form and will still be required to be in paper format.  Please keep an eye out for an email with more information and access to Final Forms mid-July.  


 Sports Physical Dates

  • Wednesday, February 7, 2018
  • Wednesday, June 13, 2018

Sports Physical Policy

Each student athlete who wishes to participate on a high school athletic team must have a physical exam within 365 days prior to the first day of practice. Sport Physicals are only valid for one year. Sport Physicals may be performed by the student's medical provider ( MD, DO, APN, PA ) or the school physician.

For the annual sport physical examination, we strongly advocate that all students be seen by their medical provider to foster an ongoing provider/patient relationship, to provide opportunities for specialist referrals, laboratory testing and assessment of vaccination status. However, since seeing a medical provider is not always possible, we will offer sport physical exams by our school physician periodically throughout the year to accommodate the need for this annual exam. If any student will see his or her medical provider for this annual sport physical, then there is no real need or reason to participate in the sport physical opportunity by the school physician. One annual sport physical examination is clearly sufficient.

Documents to be submitted annually to the school nurse are as follows:

  • Health History Questionnaire (to be completed and signed by parent)
  • Physical Evaluation Form (to be completed by healthcare provider/school physician)
  • MLHS Athletic Emergency Card (to be completed and signed by parent)
  • MLHS Training Rules (to be read, dated and signed by parent and student)
  • NJSIAA Concussion Policy Acknowledgment Form (to be read and signed by both parent and student)
  • DOE Sudden Cardiac Death Pamphlet (to be read & sign-off sheet to be signed by both parent and student)

For all students planning to see their private healthcare provider for a sport physical during the summer or for that matter anytime throughout the year:

  • Sport Physicals must be recorded on New Jersey Department of Education approved physical forms. NO OTHER PHYSICAL FORMS WILL BE ACCEPTED. Only the newest version of forms (revision 2014) will be accepted.
  • The examining healthcare provider must complete all sections of the physical, including the date of the actual physical exam. All physical forms must be stamped with Physician Stamp. Sport physicals submitted with incomplete information will be returned to the parent for completion by health care provider.
  • Submit all completed Sport Physical or Medical Update packets to the Mountain Lakes High School Nurse. Completed packets may be placed in the nurse's mailbox located in the High School Main Office.

Mountain Lakes High School will require the annual submission of the following:

  • Pre-Participation Physical Evaluation - Health History Form; completed and signed by parent/guardian.
  • Pre-Participation Physical Examination - documented on an approved New Jersey Department of Education form, dated, and signed by the student's medical provider or school physician.

The annual targeted deadline for submission of paperwork is as follows:

  • Fall Sports: August 1st (or prior to first day of practice for fall sports)
  • Winter Sports: November 1st (or prior to first day of practice for winter sports)
  • Spring Sports: February 1st (or prior to first day of practice for spring sports)

No student will be allowed to practice or participate in any sport without a current, valid physical exam on file in the MLHS Health Office. Paper work packets are always available during the summer months in the MLHS Main Office and throughout the school year in the MLHS Nurse's Office or may be downloaded from the district web site. We are planning for total online management of sport forms sometime during this calendar year.

Baseline ImPACT Concussion Testing:

All incoming freshmen and any other new student athlete transferring into the district who is planning to participate in a sport, will need to have baseline ImPACT Concussion Testing before the first day of practice. All student athletes will have repeat ImPACT baseline testing every two years. In most cases that would fall before the 11th grade sport seasons. Individual and team athletes will be notified by the athletic trainer of appointment days and times.

Medical Update Process:

An annual sport physical needs to be submitted to the High School Nurse's Office. A medical update needs to be completed by the parent/guardian for each subsequent sport season during the school year after the annual physical was submitted. This medical update is in fact, an update of the student's health history or status since the last medical/physical exam. Either a sport physical or a medical update needs to be submitted within 90 days of the first practice session for every sport season whenever a student athlete intends to participate in a high school sport.

The Medical Update sport paperwork packet consists of the following documents:

  • MLHS Athletic Emergency Card (to be completed and signed by parent)
  • MLHS Medical Update (to be completed and signed by parent)
  • MLHS Training Rules (to be read, singed and dated by both parent and athlete)
  • NJSIAA Concussion Policy Acknowledgment Form (to be read, signed and dated by both parent and athlete)
  • DOE Sudden Cardiac Death Pamphlet (to be read & sign-off sheet to be signed by both parent and student)

Injuries and/or Major Illnesses and Medical Clearance:

If a student athlete suffers an injury or major illness, which requires medical care and treatment by a healthcare provider, they will need to be medically cleared by their healthcare provider to resume competitive sports. A simple statement of medical clearance should be provided to the MLHS Health Office. Any modifications or restrictions for activity should be clearly stated by the healthcare provider.

Sports Physical Forms

Part A: Health History Questionnaire

Part A: Health History Questionnaire is to be completed by parent and student and reviewed by examining provider at time of annual sport physical exam.

Currently, the New Jersey Department of Education version from 2014 is the only acceptable form.

Part B: Physical Evaluation Form

Part B: Physical Evaluation Form is to be completed by the examining licensed provider MD, DO, APN, or PA.

Sport Physical paperwork which is incomplete with blanks or missing information will be returned to parent for completion by provider. Final page of evaluation form must be signed and stamped by physician/provider who performs sport physical along with the date of the actual sport physical exam.

Currently, the 2014 version of the New Jersey Department of Education is the only acceptable sport physical format form. No other version of any type of sport physical forms will be acceptable.