Sports Participation requires a new set of forms and procedures as per the NJ State Department of Education. (see letter here) Please take a look as there has been a change in the requirements for submission of the updated PPE. The History Form and the Physical Examination Form within the packet do not need to be submitted to the student’s school. The History Form and the Physical Examination Form should be kept by the healthcare provider who completes the PPE. Only the completed Medical Eligibility Form should be submitted to the school. The Medical Eligibility Form provides space for the healthcare provider to share relevant health information with the school if necessary and includes a recommendation regarding the student’s ability to participate in athletics. It is important to note that the PPE must be conducted by a licensed physician, advanced practice nurse, or physician assistant who has completed the student athlete cardiac assessment professional development module developed by the NJDOE.

1. Athletic Permission Slip – signed by parent (Required for each Sport/Season – declaring which sports)
2. Athletic Code of Conduct (pdf) – signed by athlete & parent
3. PPE History Form – filled out by parents and given to physician to keep on file
4. Annual Athletic Pre-Participation Physical Examination Form (PPE) – – filled out by Physician and kept on file in Physician’s office. (3rd Grade – 8th Grade: Physical form for Sports) 
5. PPE Medical Eligibility Form – signed by physician and returned to nurse’s office 
6. Health History Update Questionnaire – signed by athlete & parent – (Only needed if physical was completed 90 days or more prior to the first day of practice)
7. Sudden Cardiac Death Pamphlet Parent-Guardian Sign-Off Form (N.J.S.A. 18A:40-41d)  – signed by athlete & parent (State required) after reading Cardiac Pamphlet.
8. Opioid Use and Misuse Educational Fact Sheet and Parent/Guardian Sign-Off Form  – signed by athlete & parent (State required) after reading Opioid Use and Misuse Educational Fact Sheet
9. Concussion Fact Sheet and Acknowledgement Form  – signed by athlete & parent (State required)
10. Sports-Related Eye Injuries Fact Sheet for Parents/Guardians (N.J.S.A. 18A:40-41.9)

Any questions? – Mrs. Malinowski, RN will be happy to help you.
Email – lmalinowski@oakhillacademy .com
Nurse’s Office  732-530-1343 ext. 212