Class of 2010
Re: 10th Grade Physical
Dear Parent or Guardian:
The Connecticut State Law (CGS Secs. 10-206) requires a physical examination of each student entering the 10th grade. An immunization update and health history is also required. This exam must be completed between June 1, 2007 and the end of the 10th grade school year.
It is recommended that your family physician perform the examination, as he/she is the best person to evaluate your child's health. It is also recommended that you check with your physician at this time about whether your child needs a tetanus booster. If your child qualifies for free or reduced lunch , your child may have the exam completed by the school physician at no cost to you.
If you choose to have your own physician examine your child, please complete the front portion of the Health Assessment Record and bring the form to your physician. The health assessment form can be found on-line or obtained from the school nurse. It is important that the completed form be returned to the school nurse as soon as possible. The completed form can be mailed to the school nurse or faxed to 860-344-2232.
If you choose to have the school doctor examine your child, please complete the front portion of the enclosed Health Assessment Record. Return the form and a signed permission slip (below) to the school nurse as soon as possible. An appointment will be set up for your child to see our doctor.
Please feel free to call me at 860-344-7100, ext 318 with any questions or concerns.
Sincerely,
Debra Ismail, RN,
School Nurse
I give my permission to have my child examined by the school physician*
*(This is only available if you qualify for free or reduced lunch or there are other extenuating circumstances).
My child's physician will complete the examination
Student's Name ____________________________________________
School____________________________ Grade___________________
Parent's Signature__________________________ Date_____________