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Applicant Evaluation Form

The SKA and DRS health offices are staffed by Registered Nurses assigned by Nassau County. The nurses’ responsibilities include providing care if a student becomes sick or injured in school and maintaining current health files for each student as mandated by New York State.  In addition, various screenings such as hearing, vision and scoliosis are carried out during the year.

Your child’s health record contains a variety of forms as follows:


1.      Emergency information-  All students must submit the emergency information form (formerly the “yellow card”) every year. Please include updated cell phone, work numbers and emergency contacts and keep us updated if they change.

2.      Physical exam- NYS requires that every new entering student as well as all 10th graders submit a health form from a physical exam done since this past September. In addition to 9th and 10th grade, any student trying out for a team sport must submit a physical before tryouts are allowed. Therefore we suggest that ALL students submit physicals every year to prevent being excluded from tryouts and team sports. Please do not use camp forms as they do not give us enough information.

3.      Medication Permission- If your child is to receive any medication in school, prescription or over the counter, it must be brought in from home in an original labeled container with the permission form signed by BOTH the doctor and a parent. This includes, daily med, Tylenol or Advil, Epipens, or any other “as needed” medication. You may opt to complete the self administration part IN ADDITION to the med form if you are confident that your child is knowledgeable about his medication.

4.      Dental Form- To be completed for 9th and 10th graders.

   
The following two forms are time-sensitive.
PLEASE DO NOT COMPLETE UNTIL WE SPECIFICALLY REQUEST THEM.


5.      New York City Form- If you reside OUTSIDE of Nassau County this form must be completed annually as Nassau County bills NYC for health services provided.

6.      Sports Health Update- This form may be requested for team sports if too long of a period has elapsed since the yearly physical.


We appreciate your cooperation in returning these forms before the school year begins in September. Tryouts begin as soon as the school year starts and we want to make sure that all students are cleared for sports. In addition, we have state deadlines by which time we must submit all immunizations.

 

If you have any questions or would like to discuss anything with us privately please call the health office. Make sure to leave your name and number if we are not available to answer your call.

 

 

Thank you very much,
 
Joan Sherman, RN                                                                     Susan Sperber, RN
516-374-7195  ext . 116                                                             516-295-7700   ext.118
SKA Nurse                                                                                 DRS Nurse

 

 

Emergency Information Authorization Form

Physical Examination Form

Medication Permission Request Form

Self-Medication Release Form                                                             

New York City Form

Dental Form

Sports Health Update                                         

 

 






 
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