Parent's/ Guardians & Athletes:

Per Requirements set forth in the NJ Administrative Code-Title 6A – Chapter 16, In order to be eligible to Participate on a Somerdale Park School Athletic Team, Squad or Participate in Intramural/After-School Sports the attached “Athletic Participation Packet” must be completed in FULL & submitted to the School Nurse by the Specific Sport Deadlines as indicated in the Athletic Participation Policy Parent Letter (page1 of the packet)

Athletic Physical Participation Packet


{Print Entire Packet & Staple together and follow instructions below – If you are unable to Print please see School Nurse for a printed packet}

  1. ***Important DO NOT Remove Staple from packet- The Entire Completed Packet needs to be submitted to School Nurse
  2. Review Athletic Participation Policy Letter {pg1}
  3. Complete The “Pre-Participation Physical Evaluation HISTORY FORM” {pg2} This form must be completed prior to HCP {Health Care Provider} appointment for the HCP to review
  4. The HCP needs to complete “The Athletic with Special Needs Supplemental History Form” if warranted {pg3}
  5. The HCP needs to complete the ”Physical Evaluation Form” & the “Clearance Form” {pgs4-5}

    ***Important be sure the HCP has signed both pages, has included the DATE OF EXAM & has Included the Health Care Provider Office Stamp on page 5 {these are all required in order for the physical to be processed with the school nurse & the school physician to review & sign off the physical for FINAL APPROVAL.}

  6. If the ATHLETIC PHYSICAL EXAM DATE ON A PREVIOUSLY OR CURRENTLY submitted Physical is less than 365 days, but is greater than 90 days old on the submission deadline date for the sport your student wants to participate in, you must complete the “NJ DOE ATHLETIC HEALTH HISTORY UPDATE FORM” {see link below}