Sports

Allergy Action Plan

Annual Physical Exam K-12

Food Allergy Action Plan

Crutch Permission Form

Dental Form

Scoliosis Form - Female

Scoliosis Form - Male

Medication Form

Self Medication Release

Physical Examinations are required for:

• All new entrants
• Grades K, 1, 3, 5, 7, 9, 11
• Yearly for team sport participants

Tryouts begin: November 18, 2024                                

Registration link open: October 23, 2024 for high school athletes only. 

The registration link is a consent/permission form to play and must be completed and signed by a parent or guardian. The information you submit will be automatically sent to the school nurse who will review as part of the medical clearance. Please answer all questions and review before you submit.

Tryouts begin: November 25, 2024

Registration link open: October 30, 2024

The registration link is a consent/permission to play and must be completed and signed by a parent or guardian.The information you submit will be automatically sent to the school nurse who will review as part of the medical clearance. Please answer all questions and review before you submit.

• Complete the online registration link.
• A current physical exam must be on file and must include a blood pressure reading.
• The physical exam must be dated on or after November 1, 2023 for high school and middle school students. Please check the date of your child's last physical exam with their healthcare provider. 
• No student will be cleared without all required vaccines. 
• All allergy, medication and follow-up injury forms must be up-to-date and on file. New forms are required for each new school year, dated after July 1.

• Clearances are processed in the order in which they are received. Since there are hundreds of athletes, you may not hear for several days after you submit the form. The nurses will make every effort to complete clearances quickly.

  The nurse will email or call when your child is cleared or if additional information is required. Please check that the email address and phone numbers are correct when you complete your registration. 

Clarkstown High School North: 

• Grades 9-10: Kathleen Lennon, RN
  • Email: klennon@ccsd.edu
  • Phone: (845) 639-6571
  • Fax: (845) 638-0361
• Grades 11-12: Camilla Levine, RN
  • Email: clevine@ccsd.edu
  • Phone: (845) 639-6516
  • Fax: (845) 639-9665

Clarkstown High School South: 

• Grades 9-10: Patricia Saal, RN
  • Email: southnurses@ccsd.edu
  • Phone: (845) 624-3449
  • Fax: (845) 623-5470
• Grades 11-12: Deborah Frederick, RN
  • Email: southnurses@ccsd.edu 
  • Phone: (845) 624-3466
  • Fax: (845) 623-5470

Felix Festa Middle School:

• Grade 7: Kim Hallinan, RN
  • Email: khallinan1@ccsd.edu
  • Phone(845) 624-3971, option 3
  • Fax: (845) 639-8068
• Grade 8: Adrienne Blassberg-Milich, RN
  • Email: ablassberg@ccsd.edu
  • Phone: (845) 624-3972, option 3
  • Fax: (845) 639-8068

The sign-up link is a consent/permission to play form and must be completed by a parent or guardian. Please review everything carefully before you submit. High school registration begins October 23, 2024 and middle school registration begins October 30, 2024.

Sports sign-up link

Questions? Contact Coordinator of Health Services Sue Sherlock at (845) 620-2016 or email her at ssherlock@ccsd.edu. 

The New York State Education Department (NYSED) has recently adopted the Dominic Murray Sudden Cardiac Arrest Prevention Act. This law requires schools, students, and parents/guardians to have information on sudden cardiac arrest risks, signs and symptoms.

In order for the Clarkstown Central School District to comply with this act, we have added NYSED’s Interval Health History for Athletics questionnaire to our Sports Sign Up form. This questionnaire is intended to gather required information regarding your child’s heart health as well as your family health history to decrease any chance of Sudden Cardiac Arrest (SCA) in a student. We ask that you please read and fill out this detailed questionnaire very carefully.

The Interval Health History for Athletics questionaire must be completed and signed by a parent/guardian before each sports season unless a physical examination has been conducted within 30 days of the start of the season. School personnel may require a student with health or health history changes to see a healthcare provider before participating in athletics.As required by this new law, any student who has signs and symptoms of pending SCA must be removed from athletic activity until seen by a physician. The physician must provide written clearance to the school for the student to be able to return to athletics.

Please note that sudden cardiac arrest in children and young adults is rare. Although it can be triggered in students at risk by athletic activities, the incidence of Sudden Cardiac Death (SCD) on the playing field is 0.61 in 100,000.

SCA Signs and Symptoms:

• Fainting or seizure, especially during or right after exercise or with excitement or startle

• Racing heart, palpitations or irregular heartbeat

• Dizziness, lightheadedness or extreme fatigue with exercise

• Chest pain or discomfort with exercise

• Excessive shortness of breath during exercise

• Excessive, unexpected fatigue during or after exercise

SCA Personal Risk Factors:

• Use of diet pills, performance-enhancing supplements, energy drinks, or drugs such as cocaine, inhalants, or “recreational” drugs.

• Elevated blood pressure or cholesterol

• History of health care provider ordered test(s) for heart related issues

SCA Family History Risk Factors:

• Family history of known heart abnormalities or sudden death before 50 years of age

• Family members with unexplained fainting, seizures, drowning, near drowning or car accidents before 50 years of age

• Structural heart abnormality, repaired or unrepaired

• Any relative diagnosed with the following conditions:

  • Enlarged Heart/ Hypertrophic Cardiomyopathy/Dilated Cardiomyopathy

  • Arrhythmogenic Right Ventricular Cardiomyopathy

  • Heart rhythm problems, long or short QT interval

  • Brugada Syndrome

  • Catecholaminergic Ventricular Tachycardia

  • Marfan Syndrome- aortic rupture

  • Heart attack at 50 years or younger

  • Pacemaker or implanted cardiac defibrillator (ICD)

Please contact the NYSED Office of Student Support Services for questions at studentsupportservices@nysed.gov or 518-486-6090.