1.      Annual health history and physical examination (NEW HAR -3 Rev 2010):  Every athlete must have on record a current health history and physical examination before he/she can participate in a sport and throughout the sport season, including post season championship competitions. “Current” means that the physical examination and history have been completed within the immediate past 12 months.  Please use the NEW HAR-3 Rev 2010 to fulfill this requirement. 

a.      Part I - must be completely filled out and signed by the parent/guardian.  

b.      Part II – Medical Evaluation-- must be filled out completely and signed by the student’s physician.

c.      Part III – Immunizations – Updated as new immunizations are given.

d.      The physical examination is valid for 12 months from the date of the exam.  For example, an exam completed by the physician on October 20, 2009 will be valid until October 20, 2010. If the student does not hand in a HAR-3 Rev 2010 on or before October 20, 2010, he or she will not be able to participate in sport practice or competitions after November 20^th until such time as the athlete hands in a new (current) properly executed HAR-3 Rev 2010.  If timing of the physical examination is an issue due to health insurance restrictions, please contact one of us immediately for assistance.

e.      This form may be handed into the school nurses or to Gaetana “G” Deiso, the Head Athletic Trainer.  One of the school nurses must review it before the student will be medically cleared for participation.

f.       Please note: We will continue to accept the old Staples High School Form A and B through June 2011. Your student athlete will not be eligible to participate in the athletic program without either an old Staples High School form A and B or the new HAR-3 Rev 2010 form on file.

g.      There are no exceptions to this policy.

2. Seasonal Sport Permission/Emergency Information (Form C):
   A Form C needs to be completed and handed in for each and every sport the athlete plans to try out for EACH sport season.  Form C is a carbon-copy GOLD form that includes emergency contact information and permission for emergency medical treatment in the event that a student is injured at an away game and needs to be transported to a medical facility.
   1. This form should be “verified” by the Athletic Trainers or the school nurses.  The coach will receive the top copy of form C and the bottom copy will reside with the Athletic Trainers. 
   2. These forms will NOT be accepted if they are handed in to a coach or person other than those designated above.  There have been too many errors, including lost forms and delays in student participation, when forms are not brought to the proper place for review and processing.

Please note we will need 2 copies of Form C if it is downloaded. Both forms must be filled out using a pen. A form that is filled out in pencil will not be accepted.  If you complete the forms and turn them in as described above, your student athlete should have a smooth start each sport season.

If you have any further questions regarding these instructions, please call “G” at (203) 341-1264.  “G” will be checking her voicemail periodically throughout the summer. If you have a question regarding your student’s medical clearance or a medical issue, please contact the Health Office staff, at (203) 341-1231. 

Forms can be mailed or handed in at the Health Office, not the Athletic Office.  During most days in August, a health assistant and nurse will be in the Health Office to receive forms, but because of schedule variability, it is best to call before coming. Enjoy the summer and please complete and return or mail the forms for fall sports as soon as possible.