REQUIRED MEDICAL DOCUMENTATION
4940696
SUMMER ACTIVITIES PROGRAMS  
Physical Examination
Must be completed on the School District Physical Appraisal form. 
Valid for one full year.
 
Please mail the form to:

Summer Recreation
Hicksville HS
180 Division Ave
Hicksville, NY 11801
 
Click Here

The Nassau County Department of Health regulations require that upon registration in the summer recreation program, all students must have a current physical examination and immunization record completed. The physical must be completed and dated after August of last year. In addition, in keeping with State Education Law, we require a signed statement from your child’s Health Care Provider indicating that he or she has received the following immunization:

·        3-5 doses of Polio vaccine

·        4-5 doses of Diphtheria, Tetnus, Pertussis vaccine

·        2 dose of live Measles, Mumps, Rubella vaccine  

·        1-2 doses of Varicella

·        All Students must have either the three dose or two dose schedule of Hepatitus B Vaccine

·        T-Dap for grades 7/8


Any physical examinations within the past year must be updated by completing and returning the enclosed Medical Form only. 
 
Please have your physician complete this form. If your child’s physical expires during the camp session you will be required to supply a new, update physical. 

 

Thank you for your cooperation and we look forward to a wonderful Summer Recreation Program at Hicksville Public Schools.

 

 

         

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