Stuart Physical Examination Form is required for:

• All Middle and Upper School athletes
• All new students
• All students entering Early Childhood, Junior Kindergarten, Kindergarten, Grades 3, 6, 9 and 11.

Please see additional information below on immunization requirements and concussion forms. Physical Exam and Immunization Forms are due in Magnus by July 17.

All athletes are required to turn in a completed through Magnus by July 17. In addition, Upper School athletes must read and complete the following:

• Concussion Consent Form
• Sudden Cardiac Death Basic Facts
• Sudden Cardiac Death Acknowledgement Form
• Health History Update Questionnaire (PDF) (Required of Middle and Upper school athletes whose physical examinations occurred more than ninety days before the beginning of the season)

   

Please contact the trainer, Megan Cianfrone at mcianfrone@stuartschool.org to make an appointment for concussion testing.

All Middle and Upper school athletes, whose physical examinations occurred more than ninety days before the beginning of the season, must complete the “Health History Update Questionnaire” prior to the first day of practice.

Health History Update Questionnaire

*IMPORTANT: Stuart cannot accept hard copies of medical forms. All information must be uploaded to Magnus, and any medical information sent to the school will be destroyed for privacy and safety reasons.

Preschool Immunization Requirements:

All students entering school must be up to date on all immunizations. Proof of immunizations must be submitted to the health office prior to the start of school.

 

Kindergarten Immunization Requirements:

All students entering kindergarten must submit proof of their second varicella and second MMR (measles, mumps, and rubella) vaccination prior to the start of kindergarten.

 

Grade 6 Immunization Requirements:

Every September all students entering 6th grade, who will be 11 years of age or older before the first day of school, are required to receive a booster of the Tdap (tetanus, diphtheria, and acellular pertussis) and one dose of the meningococcal vaccine. These immunizations requirements must be met before the first day of school and proof must be submitted to the school nurse. Failure to complete these requirements will result in exclusion of the student. If the student does not turn 11 until after the first day of school, she will need to meet the requirement within 30 after her 11th birthday.

 

All new students – Immunization Requirements:

All new students must submit proof of all required immunizations to the health office prior to the start of school.

All children between the ages of 6 months – 59 months must receive the influenza vaccination annually before December 31. Please submit proof of vaccination to the health office as soon as the child receives the vaccination. If your child does not receive the vaccination due to medical reasons, a medical exemption notice must be written by the pediatrician.

Students with allergies/asthma:

If your daughter has allergies or asthma, please have your daughter’s physician complete the Allergy Action Plan and/or Asthma Action Plan.

• The medication together with the forms MUST be supplied by the parent/guardian directly to the health office.
• If your daughter is prescribed an Epinephrine auto injector or an inhaler, the medication MUST be supplied to the health office.
• If your daughter self-carries the medication, a second auto-injector or inhaler MUST be kept in the health office.

Allergy Action Plan Form

Asthma Action Plan Form

Parental Consent for Self-Administration and Self-Carry of an Auto-Injector or Inhaler

Students taking daily medication:

If your daughter is required to take medication during the school day, the Permission to Administer Medication in School form must be completed by your daughter's physician and submitted directly to the health office. The medication and the form must be brought in by the parent/guardian in the original pharmacy labeled container and handed over to the nurse.

Permission to Administer Medication in School

Field Trip Medication Request Form