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Required NYS School Health Examination Form
Note: NYSED requires a physical exam for new entrants and students in Grades Pre-K or K, 1, 3, 5, 7, 9 11; annually for interscholastic sports; and working
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PHYSICAL FORM FOR CHILD
PHYSICAL EXAMINATION. Date of exam (month, day, year). Age of child. Skin. Lymphnodes. Eyes. Ears. Nasopharynx. Teeth and Mouth. Heart. Lungs. Abdomen.
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CURRICULUM FOR GRADES 68
List physical activities and/or sports your child enjoys: All students should have a Health History Form on file as well as a parental/guardian.
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