Forms

Forms

Asthma Forms

These forms are for asthma management. Includes asthma emergency treatment plan and medication prescription forms.

Asthma Form

Allergy Forms

These forms are for allergic reaction management. Includes emergency treatment plan and medication prescription forms.

Allergy Forms

Diabetes Management plan

For student with diabetes. All forms must be completed appropriately and medications provided to the school nurse no later than the 1st day of the school year.

Diabetes Management Forms

Seizure Management Plan

This for students with seizures, form should be completed appropriately and submitted to the Nurse with any prescribed medication no later than the 1st day of the school year.

Seizure Management form

Athletic Physical Package

These forms are for students who will participate in a school sponsored athletic team or squad during the academic year. Valid for 365 days.

Sport physicals must be recorded on New Jersey Department of Education approved physical forms. NO OTHER PHYSICAL FORMS WILL BE ACCEPTED. Only the newest version of forms will be accepted.

The examining healthcare provider must complete all sections of the physical, including the date of the actual physical exam. All physical forms must be stamped with a physician stamp. Sport physicals submitted with incomplete information will be returned to the parent for completion by the health care provider.

Athletic Physical Forms

Health History Update Questionnaire 

This form is for athletes whose physical examination was completed 90 days prior to the first day of official practice.

Health History Update Questionnaire Form

Health Physical Form

Needed by the health office for health history updates. Completed by parent and student`s Physician or Advanced Practice Nurse (APN). Please attach immunization records.

Health Physical Form

OTC and Prescription Medication Form

This form is for prescription and Over the Counter (OTC) medications. Must be completed by parent and physician before medication can be administered at school by the school nurse.

OTC and Prescription Medication Form

Authorization for Administration of OTC Medication for Acute Illness at School

The school physician has authorized the administration of Tums, Ibuprofen, and Tylenol if needed with parent`s/guardian`s permission.

OTC Medication for Acute Illness Form

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About Us

CJCPCS motivates every student, without exception, to make acceptance into a four year university their goal for the future after high school.

Contacts

101 Mettlers Road
Somerset, NJ 08873
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  732-649-3954
 848-216-3183