MONROE TOWNSHIP PUBLIC SCHOOLS
                                  Monroe Township Middle School
                             1629 Perrineville Road • Monroe Township, NJ 08831
                               Telephone (732) 521-6042 Fax (732) 521-3129

Chari Chanley, Ed.S.                           James Higgins                                Scott Sidler
Principal                                     Assistant Principal                    Assistant Principal

October 1, 2012

Dear Parent/ Guardian,

All students interested in participating in a winter sports team must have a sports physical. Your
daughter/son must have a health questionnaire (part A), physical exam form (part B), and parental consent
form completed and on file in the nurse’s office prior to trying out for any school sport. It is not
necessary for middle school parents to fill out and sign the Steroid Testing Consent Form. If your child
has a physical on file in the nurse’s office and it is current (can’t be older than 365 days from the date of
the first try out) this will satisfy the requirement of a physical exam. If a patent/guardian chooses to take
their child to their own physician they must obtain the above mentioned documents and take them at the
time of the physical to their doctor. The doctor must sign that they have read Part A Health History
Questionnaire. All physicals must be completed to include vision screening. Any physical not completed
will be returned to the family.

Students may receive physicals from either their private physician or by the school doctor. Every student
going out for a winter 2012-2013 sport must have a physical either by our school physician or by their
own physician on or before Tuesday, October 30, 2012. The school physician will be available for
physical appointments on Tuesday, October 23, 2012 & Tuesday, October 30, 2012. Physicals will
take place at the Monroe Township Middle School Nurse’s Office during school hours. There is no
charge to receive a physical by the school physician. Any student that does not receive a physical by the
school physician on the above mentioned dates is responsible to receive a physical by their private
physician. In order to participate for a winter sport, ALL paper work is due in the MTMS nurse’s
office no later than Thursday, November 1, 2012. Please remember that if your child handed in
paperwork to participate in tryouts for the fall 2012 season they must still hand in updated paperwork
(health questionnaire – part A & a parental consent form) to the nurse’s office by Thursday,
November, 1, 2012

All pre-participation, parental consent and physical forms are available on the Monroe Township High
School website under the athletics link and in the high school and middle school nurse’s office. Please
make sure all forms are signed prior to the physical date. To schedule an appointment, please contact
Mrs. Dowd or Mrs. Torrillo at 732-521-6042 Ext. 2004 or e-mail them@ or


Deborah Dowd                          Shirley Torrillo                      Cheryl Whinna
Deborah Dowd, RN                      Shirley Torrillo, RN                  Cheryl Whinna
MTMS School Nurse                     MTMS School Nurse                     MTMS Athletic Coordinator

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