Health Screening Opt-Out Form

Dear Parent/Guardian,
Throughout a typical school year, multiple health screenings required by the state of New Jersey are conducted. As per, N.J.A.C. 6A:16-2.2(g)3 and N.J.A.C. 6A:16-2.3(b)3ii
mandated health screenings include height, weight, blood pressure, hearing, vision, and scoliosis.
Please note that many of these screenings are typically a part of the physical for sports, entry to school or annual well visits. Health screening information provided on these documents that were submitted this year will satisfy the mandatory requirements. Some school-based screenings may have already been completed.
If your child has received a physical during the 2020-2021 school year, please forward to your school nurse immediately.
A failure to complete and return this form will be considered an
OPT OUT OPTION for screenings for the 2020-21 school year