Incoming 6th Grade Medical Requirements

Incoming 6th Grade Medical Requirements
Posted on 08/17/2017
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January 2017

Dear Parents/Guardians,

As you prepare to transition your child to Holdrum Middle School, there are several health items that you need to be aware of. To help expedite paperwork for this transition we are hoping to get these forms into your hands earlier, so you can arrange physicals with your doctors prior to the summer rush. The information below is also outlined in detail on the Health Forms Page on the HMS website.



  • All students entering 6th grade must receive one dose of Tdap (Tetanus, Diptheria, Pertussis) on or after their 10th birthday. Record of student receiving this immunization is required.
  • All students entering 6th grade must receive one dose of a Meningococcal-containing vaccine. Record of student receiving this immunization is required. 
  • A physical examination is required for admittance to 6th grade for ALL students. This physical must be submitted on the New Jersey Department of Education Annual Athletic Pre-Participation Physical Examination Form. This is the ONLY form accepted and is available on the River Vale School District’s website. Please complete the History Form (page 1) and Supplemental History Form, if applicable (page 2), sign and date it and bring it to your child’s physician to be reviewed. The physician must complete the Physical Examination and Clearance Forms (pages 3 & 4). Your physician must sign, stamp and date each page. Only original documents will be accepted. This form must be complete. Incomplete forms will be returned.

Please note that the Annual Pre-Participation Athletic Physical is valid for 365 calendar days.   

In addition to above, all students who wish to try out for a sport must follow additional state mandated guidelines. If the physical examination was more than 90 days prior to the first day of practice/try-outs a Health History Update must be completed and signed by the parent. This 90 day Health History Update is required for each season that a student is interested in trying out for and participating in. All students trying out for a sport must submit a completed Concussion/Cardiac Arrest Parent Signoff. All forms can be found on the Holdrum website.

If you have completed the physical forms, documentation of immunizations prior to May 31, 2017 please submit them to the school nurse at your child’s current elementary school for her review. She will be able to tell you if you are missing any forms prior to the end of the school year. Those forms will then be forwarded to Holdrum Middle School for the HMS nurse’s review as well as the final approval by the district physician. If you complete the physical forms after June 1, 2017 please submit them directly to the Holdrum Main Office.

Be sure to submit these forms as soon as possible to ensure enough time for the district physician to review and approve all paperwork. All required documents must be submitted no later than August 1, 2017. This deadline is imperative to make sure students are approved to try out for sports, as well as for entry to Holdrum Middle School. Please submit all forms together as a complete packet.

If you have any questions, please don’t hesitate to call the school nurse, Mrs. Phyllis Kollar at 201-358-4016 ext. 1020.

Yours in education,

James P. Cody
Principal

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