BERNARDSVILLE MIDDLE SCHOOL SPORTS
2016-17 WINTER SPORTS INFORMATION
MEDICAL /SPORT Participation Forms and Documentation will be accepted from Monday, October 10, 2016 - DEADLINE Monday, October 31, 2016 to the BMS Sports Box in the main office.
A mandatory part of our Middle School Athletic Sports Program for 6-8th Grade Students is the state requirement of a Health History and Physical Examination.
The examination MUST be conducted within 365 days of the first tryout/practice date (November 14th) and MUST be documented on the State mandated Sport Participation Forms (see below). A Health History update must be submitted if the Physical date is 90 days old on the first tryout/practice date. ***** Please note that the Athlete with Special needs, Supplemental history form which is a part of the pre-participation physical must only be completed if applicable******.
It is the responsibility of the parent/guardian to check the date of their child’s last physical examination to ensure that it is current, according to the guidelines above. In addition, it is imperative that all Medical/Sport Participation Forms be submitted to the BMS SPORTS BOX in the main office on or prior to the registration deadline of Monday, October 31st.
Forms must be completed in full-all lines filled in and “yes” answers explained. The school physician MUST review all medical documentation and makes the final determination as to whether or not a child is medically approved to participate. School Physician approval to participate in a Winter sport requires a minimum of one week from submission of all completed forms. If the child’s physical must be scheduled to be completed on or after October 31, 2016, please contact Nurse Ryan at firstname.lastname@example.org and state such in an email, along with a date of scheduled treating physician annual physical.
The New Jersey Department of Education state mandated forms include:
1. NJ Pre-Participation Physical Examination form- *Including VISION EXAM completed for ALL. ** ATHLETE with Special Needs Supplemental History Form completed only if applicable.
2. Health History Update Questionnaire Form : Must be completed if Physical Exam is more than 90 Days old prior to the first day of Practice/tryout (November 14th)
3. Sudden Cardiac Death Pamphlet Sign-Off Form- * Complete once per school year. Parent and Student signature.
4. NJSIAA Concussion Policy Form- * Complete once per school year. Parent and Student signature.
5. Emergency Contact Information - with parent signature (each season)
6. Player Permission Form - with parent signature (each season)
*****ALL Forms to be submitted to the BMS SPORTS BOX in the BMS Main Office ******
Details on Forms Below
1. NJ Pre Participation Physical Examination Form : A physical that is less than 365 days old from the first day of the start practice must be submitted. Print the 4 page Pre-Participation Physical Evaluation Form, Medical and Registration Forms. Parent or Guardians should complete and sign the History Form, and then have the athlete sign the the form. Bring the forms to the participant’s physical examination appointment with your treating physician. The Physician will review the forms, complete the Physical Examination Form and the Clearance Form during the exam for a physical administered within 365 days before first day of official practice. Make sure all sections are complete . Make sure physician stamp is next to physician signature. Make sure date of exam is included on top left. Make sure Vision portion is complete. Make sure the Athlete with Special Needs Supplemental History Form is complete (if applicable). Make sure Cardiac Module is completed by physician. Incomplete forms will be returned. Staple all forms together and submit to the BMS SPORTS BOX in the BMS Main office by the Monday, October 31st deadline.
2. Health History Update Questionnaire Form : In order to participate on a school-sponsored interscholastic or intramural athletic team or squad, each student whose physical examination was completed more than 90 days prior to the first day of official practice shall provide a health history update questionnaire completed and signed by the student’s parent or guardian.
3. Sudden Cardiac Death Pamphlet Sign-Off Form *: Complete once per school year* . All student and parents must review the Sudden Cardiac Death in Young Athletes pamphlet that can be found below. Students and Parents must complete and sign the Sudden Cardiac Death Pamphlet Sign-Off Sheet and submit it with physical and/or health history update questionnaire.
4. NJSIAA Concussion Policy:* Complete once per school year*. : All students and parents must complete and sign this form once per school year.
5. Emergency Contact Information Form: Must be completed and signed by parents each season .
6. Player Permission Form- Must be completed and signed by parents each season .