Health Office & Sports

Explanation of SportS Forms


Forms Required

1) NYS School Health Examination Form for sports (REVISED JUNE 2018)

This two page form is available online, in the Health Offices, Main Offices and High School Athletic Office. All athletes participating in sports need this form completed. The physical is good for one calendar year and only needs to be submitted once a year.

2) Athletic Health History/Permission Form: (formally called Interim Form)

Permission forms are available in the same locations as the NYS School Health Examination Forms. It is a one-page form with questions pertaining to the athlete’s health history. A Parent must sign this form. Any question answered “yes” must be explained on the back of the form. The Athletic Health History/Permission Form is necessary every season.

3) Yellow & White Cards:

These can be found in the Health Offices, Main Offices, and High School Athletic Office. Separate cards are required for each sport in which the athlete participates.

HIGH SCHOOL requires a yellow card filled out and signed by a parent and athlete and a white card filled out on both sides and signed by a parent and athlete on both sides

MIDDLE SCHOOL requires a yellow card only, filled out and signed by a parent and athlete

Please note that all forms necessary must be fully completed or the athlete will not be cleared for sport participation. You can start handing in Interim forms and cards 30 days before the start of the sport and it can take up to 48 hours to be cleared. Handing in any forms late may result in the athlete not being cleared for the start of the season.


Accident Insurance

· Be sure to notify the coach and school nurse of any accident

· Your insurance company is the primary insurance for your child and must be used first

· The District’s insurance company has a $500 deductible

· Notify the school nurse if you anticipate more than $500 out of pocket expense after your insurance company has been used, then the District’s insurance application will be mailed to you

· You must report the accident to the District insurance company within 90 days of the accident

· After the deductible, you will be reimbursed 90% of “usual & customary charges”

· If you do not have insurance for your child, the District’s insurance will become your primary insurance, please request the application from the school nurse


The Board of Education of the North Shore School District recognizes that concussions and head injuries are commonly reported injuries in children and adolescents who participate in sports and recreational activity and can have serious consequences if not managed carefully. Therefore, the District adopts the following policy to support the proper evaluation and management of head injuries.

Concussion is a mild traumatic brain injury. Concussion occurs when normal brain functioning is disrupted by a blow or jolt to the head. Recovery from concussion will vary. Avoiding re-injury and over-exertion until fully recovered are the cornerstones of proper concussion management.

While district staff will exercise reasonable care to protect students, head injuries may still occur. Physical education teachers, coaches, nurses and other appropriate staff receive training to recognize the signs, symptoms and behaviors consistent with a concussion. Any student exhibiting those signs, symptoms or behaviors while participating in a school sponsored class, extracurricular activity, or interscholastic athletic activity shall be removed from the game or activity and be evaluated as soon as possible by an appropriate health care professional. The School Nurse or Athletic Trainer will notify the student’s parents or guardians and recommend appropriate monitoring to parents or guardians.

If a student sustains a concussion at a time other than when engaged in school-sponsored activity, the district expects the parent/legal guardian to report the condition to the Coach, Teacher, Nurse or Athletic Trainer, so that the district can support the appropriate management of the condition.

The student shall not return to school or activity until authorized to do so by an appropriate health professional. The school’s chief medical officer will make the final decision on return to activity including physical education class and after-school sports. Any student who continues to have signs or symptoms upon return to activity must be removed from play and reevaluated by their health care provider.

The Superintendent, in consultation with appropriate district staff, including the chief school medical officer, will develop regulations and protocols to guide the return to activity.



Concussion education is provided for all administrators, teachers, coaches, school nurses, athletic trainers and guidance counselors. Education of parents will be accomplished through preseason meetings for sports and/or information sheets provided to parents. Education will include, but not be limited to the definition of concussion, signs and symptoms of concussion, how concussions may occur, why concussions are not detected with CT Scans or MRI’s, management of the injury and the protocol for return to school and return to activity or interscholastic athletics. The protocols will cover all students returning to school after suffering a concussion regardless if the accident occurred outside of school or while participating in a school activity.

Concussion Management Team

The District has assembled a concussion management team (CMT). The CMT will consist of Dr. John Sheehy-- School Doctor, Don Lang-- Athletic Director, Janice Nunziata-- School Nurse and Michael Gonzalez--Athletic Trainer. The District’s CMT will coordinate training for all administrators, teachers, coaches and parents. Training is mandatory for all coaches, assistant coaches and volunteer coaches that work with these student athletes regularly. In addition, information related to concussions will also be included at parent meetings or in information provided to parents at the beginning of sports seasons. Parents need to be aware of the school district’s policy and how these injuries will ultimately be managed by school officials.

Training includes: signs and symptoms of concussions, post-concussion and second impact syndromes, return to play and school protocols, and available area resources for concussion management and treatment. Particular emphasis should be placed on the fact that NO athlete will be allowed to return to play the day of injury and also that ALL athletes should obtain appropriate medical clearance prior to returning to play or school.

The CMT will act as a liaison for any student returning to school and/or play following a concussion. The CMT will review and/or design an appropriate plan for the student while the student is recovering.

Concussion Management Protocol

Return to play

Return to play following a concussion involves a stepwise progression once the individual is symptom free. There are many risks to premature return to play including: a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that can result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alteration in balance. These NYSPHAA current returns to play recommendations are based on the most recent international expert opinion. *No student athlete should return to play while symptomatic. Students are prohibited from returning to play the day the concussion is sustained. If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion. Once the student athlete is symptom free at rest for 24 hours and has a signed release by the treating clinician, she/he may begin the return to play progression below (provided there are no other mitigating circumstances).

Day 1: Light aerobic activity

Day 2: Sport-specific activity

Day 3: Non-contact training drills

Day 4: Full contact practice

Day 5: Return to play

Each step should take 24 hours so that an athlete would take approximately one week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the student should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed.

[*These NYSPHAA current returns to play recommendations are based on the most recent international expert opinion.]

Concussion Checklist

Student Parent Concussion Information