Sports and Activities

Freehold Township Board of Education

Sports & Activities

(732) 431-4403

 

Michael Benjamino

Coordinator of Athletics & Co-Curricular Programs

(732) 431-4403

 

The Pre-participation Physical Evaluation Medical Eligibility Form for fall sports is due back to the district by August 23, 2024. The entire School Physical Packet is no longer required to be submitted to the district. That packet will now stay with your student's physician. You can find those documents here.

 

Original Pre-participation Physical Evaluation Medical Eligibility Forms should be delivered to the middle school your child will be attending.

 

School sports are offered during the fall, winter and spring seasons. They include:

  • Fall Sports: Boys'/Girls' Cross Country, Girls' Field Hockey, Boys'/Girls' Soccer
  • Winter Sports: Boys'/Girls' Basketball, Cheerleading, Wrestling
  • Spring Sports: Baseball, Softball, Track & Field

 

Fall Sports season begins on September 16, 2024.

 

Sports physical forms are available to print at home by clicking here or following the link on this memo. They are also available for pick-up at the main office of either Freehold Township Middle School.

 

Clifton T. Barkalow Middle School

498 Stillwells Corner Road

Freehold, NJ 07728


Nurse: Mrs. Larisa Ippolito, RN

[email protected]

732-431-4403 x2108

Dwight D. Eisenhower Middle School

279 Burlington Road

Freehold, NJ 07728


Nurse: Mrs. Debbie King, RN

[email protected]

732-431-3910 x4108

 

The Scholastic Student-Athlete Safety Act (SS-ASA) (N.J.S.A. 18A:40-41.7) mandates that sports physicals may only be completed by a licensed physician, advanced practice nurse (APN) or physician assistant (PA) who has completed the Student-Athlete Cardiac Assessment professional development module. The licensed physician, APN, or PA must sign the certification statement on the Pre-participation physical form attesting to the completion of the professional development module. The Pre-participation Physical Evaluation Medical Eligibility forms will not be accepted without the healthcare provider’s stamp and signature in the certification statement section. The student will not be cleared to participate in their sport unless your healthcare provider completes the Student-Athlete Cardiac Assessment professional development module AND signs the certification statement. It is recommended that you verify that your medical provider has completed this module before scheduling your sports physical appointment.

 

The Annual Athletic Pre-Participation Physical Examination Forms are required by the New Jersey Department of Education.  These forms are required for any middle or high school student in New Jersey who wants to participate in an interscholastic or intramural sports program. Students must have their exam approved by the school physician before they may participate in practice or tryouts. Our school physician is scheduled in advance to review all the sports physicals for the entire district. 

 

Forms that are submitted late or incomplete cannot be guaranteed to be approved by the school physician. Students who have not received clearance by the school physician may not participate in any practice or tryout. Please adhere to all deadlines and guidelines to ensure that your child is able to participate.

 

History Form

 

  • Must be completed in full by the parent or guardian.
  • Must explain all “yes” answers, including dates, length of symptoms, and treatment. You may attach a second piece of paper if more room is needed.
  • The parent or guardian and student must sign and date the form.
  • The date on the history form must also be the same date as the physical exam.
  • This form must be reviewed by the health care provider at the time of examination.

 

Special Needs Supplemental History Form

 

  • Must be completed and signed by the parent or guardian even if the student does not have a disability.
  • The parent or guardian must sign and date the form.

 

Physical Examination Form & Clearance Form

 

  • Must be completed in full by the health care provider.
  • Both forms must be signed, stamped, and dated by the health care provider.
  • All “indicators” must be filled in by the examiner. This includes height, weight, blood pressure, pulse, and vision.
  • Health care provider signature in the Cardiac Assessment Professional Development section is required.
  • Incomplete forms will be returned for completion by your health care provider per NJ Administrative Code.

 

Health History Update Questionnaire

 

  • This form must be submitted if a valid physical form is already on file in the health office.
  • It must not be dated more than 90 days prior to the first practice or tryout.
  • Must be completed in full by the parent or guardian.
  • Complete one form per season (not sport).