Dwight D. Eisenhower Middle School

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Health Office
 
School Nurse: Mrs. Debbie King RN
email: dking@freeholdtwp.k12.nj.us
@DDEschoolnurse
Phone: (732) 431-3910 Ext: 4108
 
Physical Forms Information
  • Physical forms will not be accepted without the healthcare provider’s signature in the cardiac certification statement section.
  • The deadline to turn in forms for winter sports is February 21, 2017.
  • The spring sports season starts on March 7, 2017.
  • Not sure if your child has a valid sports physical and health history on file? Click here.
  • Sports Physical forms are available on the sidebar of this page or may be picked up at the school.
 
The Annual Athletic Pre-Participation Physical Examination Forms are required by the New Jersey Department of Education. These forms are required for any middle or high school student in New Jersey who wants to participate in an interscholastic or intramural sports program. Students must have their exam approved by the school doctor before they can participate in practice or tryouts. Our school doctor is scheduled in advance to review all the sports physicals for the entire district. Forms that are submitted late or incomplete can not be guaranteed to be approved by the school physician before the season starts. Students who have not received clearance by the school doctor may not participate in any practice or tryout. Please adhere to all deadlines and guidelines to assure that your child is able to participate.

History Form
  • Must be completes in full by the parent/guardian.
  • Must explain all 'yes' answers; include dates, length of symptoms and treatment. You may attach a second piece of paper if more room is needed.
  • The parent/guardian and student must sign and date.
  • The date on the History form must be the same date as the physical exam *This form must be reviewed by the health care provider at the time of examination
 
Special Needs Supplemental History Form
  • Must be completed and signed by the parent/guardian even if the student does not have a disability. The parent/guardian and student must sign and date.
 
Physical Examination Form and Clearance Form
  • Must be completed in full by the health care provider.  
  • Both forms must be signed, stamped and dated by the health care provider.
  • All “indicators” must be filled in by the examiner; this includes height, weight, blood pressure, pulse and vision.
  • Health care provider signature in the Cardiac Assessment Professional Development section.
  • Incomplete forms will be returned for completion by your health care provider per New Jersey Administrative Code.
  • Exams conducted on or after 03/08/16 are acceptable for the SPRING 2017 season.
 
Health History Update Questionnaire (Blue Form)
  • This form must be submitted if a valid physical is already on file in the health office.
  • Dated no more than 90 days from the first practice/tryout
  • Must be completed in full by the parent/guardian
  • Complete 1 form per season not sport.



    THE DEADLINE TO TURN IN FORMS FOR SPRING SPORTS IS FEBRUARY 21, 2017.


    Click here to access the Freehold Township Middle School Sports Website for additional information.



                  Information Regarding School Attendance

As you are aware, the State of New Jersey has revised the laws regarding school attendance. In order to be in compliance with these laws, the Freehold Township Schools have created board policy to govern student attendance in Freehold Township. A summary of the policy can be found in the student handbook you received in September.

School board policy requires that the school receive a written note for each school absence with the parent's original signature. This note should state the date and reason for absence. We have created a form which may make it easier for you to fill out and send in the required information. You can complete the form in place of a note and return it the day your child returns to school. Immediately following any future absences, you can always refer to this site to access the form or you may write an absence note to your child's teacher. We appreciate your cooperation with this policy.
 
See sidebar for Form for Absence.
Human Papillomavirus:
For information from the New Jersey Department of Education see below.
Sudden death in athletes between the ages of 10 and 19 is very rare.  What, if anything, can be done to prevent this kind of tragedy?  Read below to learn more.  
Physical Forms to Download
 
Parent Absence Form to Download