Sports Physical Dates
  • Wednesday, November 5, 2014
  • Wednesday, February 4, 2015
  • Wednesday, June 17, 2015 (tentative)

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.
 
Sport Physicals for students entering Grades 9-12, will be conducted on Wednesday, June 18th from 12:00PM to 4:00PM in the High School Athletic Trainer's Office by Dr. John Russo, School Physician. We ask that every student stop at the High School Nurse's Office for vision screening before proceeding to the Athletic Trainer's Office. If your child wears contacts or eyeglasses, they must wear them for the vision-screening portion of the sport physical.
 
We will follow this appointment schedule:
12th Graders @ 12:00Noon
11th Graders @ 1:00PM
10th Graders @ 2:00PM
9th Graders @ 3:00PM
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. (Newest DOE version, 2014)
  • 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. (Newest DOE version, 2014)
 
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 bedownloaded 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

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    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. 
    Health History 2014.pdf 272.31 KB (Last Modified on June 1, 2014)
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  • Part B: Physical Evaluation Form

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    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.
    Physical Form 2014.pdf 317.32 KB (Last Modified on June 1, 2014)
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  • Mountain Lakes High School Athletic Emergency Card

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    MLHS Athletic Emergency Card need to be completed by parent and signed. This card gives the student athlete permission to participate in the inter-scholastic athletic program.  Also, serves as a quick resource of medical information such as life-threatening allergies, chronic medical conditions and daily medications taken by student.  Emergency cards are stored confidentially in the Medic Box for each sport, each season.  All cards should be completed with name and telephone numbers of parents and other contacts so that coaches may contact parents/contacts in any sports related medical emergency.
    Emergency Card 2014.pdf 81.94 KB (Last Modified on June 1, 2014)
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  • Mountain Lakes High School Athletic Training Rules Policy

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    Mountain Lakes High School Athletic Training Rules Policy should be read, signed and dated by both parent and athlete.  The Training Rules Agreement must be completed and submitted for each sport in every year when the student athlete plans to participate in a high school sport. 
     
    The latest version of this agreement from June 29, 2010 is the only version that is acceptable.
    MLHS Training Rules Policy.pdf 895.39 KB (Last Modified on October 18, 2011)
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  • NJSIAA Parent/Guardian Concussion Policy Acknowledgment Form

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    The NJSIAA (New Jersey State Interscholastic Athletic Association) has mandated that all athletes, parents/guardians and coaches follow the NJSIAA Concussion Policy. This document must be read, signed and dated by every student athlete and their parent/guardian and submitted to the school nurse for every sport season whenever the student plans to participate in a sport.
    Concussion 2014.pdf 186.08 KB (Last Modified on June 1, 2014)
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  • Sudden Cardiac Death Pamphlet

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    DOE pamphlet to be read & sign-off sheet to be signed by both parent and student.
    Sudden Cardiac w Sign-Off.pdf 486.34 KB (Last Modified on June 1, 2014)
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  • Mountain Lakes High School Medical Update Form

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    Sport Physicals are valid for 365 days.  According to the NJDOE Administrative Code - Chapter 16-6A:16-2-2H1, each student whose medical examination was completed more than 90 days prior to the first day of practice shall provide a Health History Medical Update of medical problems experienced since the last medical examination or annual sport physical.  The Medical Update is a one page statement documenting the student's health status since the last submitted Annual Sport Physical. No student will be permitted to participate until this Medical Update form is completed by a parent and submitted to the school nurse. There is no need to see a physician/provider to complete this document, a parent completes the form.  When the school nurse reviews the Medical Update, if a Medical Clearance is required, the parent will be contacted.
    Health History Update 2014.pdf 512.28 KB (Last Modified on June 1, 2014)
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