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Sport Physical Forms

Instructions for form completion and submission:

The sport physical packet must be completed to participate in athletics for Glassboro School District. The following forms are included in this packet and must be completed:

  1. PPE MEDICAL ELIGIBILITY FORM- Medical Provider will complete and you will return this form to Glassboro Nurses.

  2. HEALTH HISTORY FORM- This form must be completed and signed by parent and student athlete before the appointment. Please make sure that all areas are complete. This form must be given to your medical provider at the time of your physical examination for review. Your medical provider may keep this form on file in their office.

  3. PHYSICAL EXAMINATION FORM- This form must be completed and signed by your medical provider. The physical examination is valid for 365 days. Your medical provider may keep this form on file in their office.

  4. ACTION PLANS- If there is a diagnosis of asthma and/or allergy needing life-saving medication, please have the action plan completed by your medical provider and return to Glassboro School nurse. Space is also provided on medical eligibility form for medication and treatment of asthma and allergies.

    Additional information:

    1. Eligibility to participate is good for 365 days from the date of the medical examination.

    2. If the examination is completed more than 90 days prior to the first practice session a Health History Update questionnaire is required and submitted to the school nurse for review and approval.

    3. All Medical Eligibility Forms are submitted to the school physician for review and approval. Additional information may be requested for clarification of medical eligibility and for appropriate clearance.

    4. All completed forms should be given to the school nurse at your child’s school. ***During summer hours the school nurse will not be available daily to collect forms. Please place the forms in the drop box in the security office at GHS. Do not give the form to your child’s coach, teacher or any other person in the school. The school nurse will be scheduling time to process forms during the summer.

      Contact GHS Nurse at: eperewiznyk@gpsd.us or TE Bowe Nurse at: SRichards@gpsd.us with any questions/concerns.

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