For Parents Caregivers


It is highly recommended that your child has yearly exams throughout their childhood as it is important to monitor their growth and health. However, Lacordaire Academy only requires a current physical exam for NEW students. The NJ State form can be downloaded here. Your physician may also use his/her own form.

For athletic participation: The only form accepted is the NJ state form. Please remember to bring this form to the physician’s office at the time of your child’s physical. Do not forget to make a copy for your own records. Fax copies CANNOT be accepted (NJ State Law).

The first page is The History Form that must be completed, signed, and dated by the Parent/Guardian and Student Athlete for Grades 6-12. Incomplete forms will not be accepted. The second page, IF APPLICABLE, is for parent to complete and both parent and student to sign and date.

The last two pages are for the examining physician to complete, sign, date with the date that the physical was done and stamp. The fourth page must be signed and dated in two fields. The first signature is for Clearance to Participate, with date of physical, the second signature and date are for the date the NJ Cardiac Assessment Module was completed.

Physicals must be done by a US licensed physician (NJ State Law ).

Original Completed Physical Forms must be returned before the first day of school in September, with a current copy of the IMMUNIZATION RECORD. Fax copies CANNOT be accepted (NJ State Law). Clearance for sports, Physical Education classes, school trips, and any school-sponsored activities will not be issued without the entire form. Please keep a copy for your own records.


Medication should be given at home whenever possible. New Jersey Law and the New Jersey Nurse Practice Act forbids any nurse to dispense medication without a written physician’s order. This includes prescription and over-the-counter medications. However, if a medication must be administered during school hours (prescription or over-the-counter), proper authorization must be provided to the school. Please click here for the Medication Administration Policy.


New Jersey Chapter 61 requires students with asthma, reactive airway disease, or breathing issues requiring the use of asthma medication to have an Asthma Treatment Plan on file with the School Nurse. For students to carry their inhaler in school, your Health Care Provider must check off approval at the bottom of the PACNJ Asthma Treatment Plan.

The PACNJ Asthma Treatment Plan is the only written plan approved by the New Jersey Department of Health and Senior Services as meeting the requirements of the New Jersey Law.


Some students have allergies to medication, foods or environmental factors. If your child has an allergy, please notify the Health Office as soon as possible. Every effort will be made to prevent an exposure to your child. If your child is taking medication at home for allergies it would be helpful to notify the nurse since some side effects of these medications can impact learning

If your child’s physician has prescribed benadryl or an Epi-pen/Adrenaclick/Auvi-Q for your child, the physician and parent must complete and sign the Food Allergy Emergency Action Plan and Consent. This information will help to service your child in the event of a life threatening allergic emergency. These forms are also available in the Health Office.


The use of crutches on school property by a student untrained in their use poses a safety risk for both the student and other persons on school property, including fellow classmates. Only a student with a documented injury and who has been trained in the use of crutches will be permitted on campus with crutches. Before a student may come to school on crutches, the family of an injured student must provide to the school nurse documentation from a physician or other appropriate medical personnel of the following information:

The use of crutches has been authorized by a physician or other appropriate medical personnel

  • The diagnosis and the duration of the authorized use of crutches
  • The student has received training in the use of crutches, particularly on stairs
  • The anticipated length of time the student will be excused from gym/recess


Download forms by clicking here.
All forms must be submitted together to the nurse’s office in order for the athletic clearance process to begin.


Download forms by clicking here.


Download forms by clicking here.