Health Assessment Records / Physical Examinations & Immunizations Information:

Mandatory Health Assessments are required for grades Pre-K, Kindergarten, 6 and 10 and need to be on the State of Connecticut Health Assessment Record. The physicals must be completed on/or after July 1st of the year the students are entering the 6th and 10th grades. Camp Physicals or Sports Physicals do not meet this requirement.

Details for Health Assessment Record: All * boxes must be completed by the physician including: height, weight, blood pressure, HCT/HGB, gross dental, scoliosis, Tuberculin test (for students coming from ANY another country), vision, and auditory evaluations prior to admission to school. (Please note that vision and auditory screenings will not be done by the school on admission — these should be performed as part of the physical examination.) Physicals are valid for thirteen (13) months.

Tuberculosis Screen: Students moving into Region 15 from ANY High Risk country need a tuberculosis screening with results interpreted/documented by their physician's office prior to entering the school district. Students traveling outside of the US to high risk areas (even for vacation) will be required to have a TB test within 6-8 weeks after return to the U.S. The date of the PPD appointment must be given to the nurse upon return. The PPD must be read 48-72 hours after it is planted and printed results must be given to the school nurse. Additional screening may be required according to the Tuberculosis Policy. For current information on high risk countries please click here.

  • Click here for Health Assessment Form / Physical Examination Form
  •  Click here for Religious Exemption Form.
  •  Click here for Medical Exemption Form. 

Sports Physicals for Middle and High School Students 

Physicals are required for sports tryouts and participation. All physicals are valid for 13 months from the date of the physical. A sports form or a State of Connecticut Assessment Record form may be used for this clearance. No student may try out without a valid physical.

  • Click here for Sports Physical Form

 

Region 15 Central Office: 286 Whittemore Road PO Box 395 Middlebury, CT 06762   Phone: (203) 758-8259   Fax: (203) 758-1908   Get Directions