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Dear Parents Guardians


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									                                          EDEN CENTRAL SCHOOLS
                                                      3150 SCHOOLVIEW ROAD
                                                      EDEN, NEW YORK 14057

Douglas N. Beetow                                                                            Office: (716) 992-3643
Athletic Director                                    July 2010                                 Fax: (716) 992-3644

Dear Parents/ Guardians:

        Yes, school has only been out a few weeks and we are already bugging you about the upcoming school
year. If your child plans on participating on any one of the many sports teams at Eden Jr./Sr. High School, they
will need to have an updated physical form on file before they begin practicing/trying-out this fall. The school is
offering physicals over the summer on Saturday August 7, 2010 in the High School Clinic @ 9:30am. Health
Appraisal Form can be picked up in the High School Main Office or the High School Clinic if you choose to go to
your family physician. You can also print off forms from our web site, under the SPORTS tab.
Print as many copies as you might need.

         If your child missed Team Sign Ups in the spring, it is not too late!!! Please have your child show up on
the first day of practice. Dates and times are listed below. I encourage all students to get involved in something,
take advantage of what we offer.

       Good luck training over the summer. The work that an athlete puts in before the start of a season will only
get them that much farther ahead of our competition. Hope to see everyone for a safe and successful fall season
and a great start to a new school year.

        Any 7th or 8th grader wishing to participate on a Varsity or JV team must pass a State Selective
Classification Test. If your child chooses to be selectively classified for the upcoming school year, testing will
occur August 26, 2010 after the 7th grade orientation. Any questions please contact the athletic office at 992-3643
or e-mail your questions to

                                                     Douglas Beetow

                      Sport                      First Day of Practice    Practice Location                     Time
              Varsity & JV Football                August 16, 2010       Football Locker Room                 7:30 AM
              Cross Country                        August 23, 2010       High School Track                    8:00 AM
              Varsity and JV Field Hockey          August 23, 2010       High School Locker Room              8:30 AM
              Golf                                 August 23, 2010       High School Cafeteria                1:00 PM
              Varsity and JV Boys Soccer           August 23, 2010       High School Varsity Soccer Field     9:00 AM
              Varsity and JV Girls Soccer          August 23, 2010       High School JV Soccer Field          9:00 AM
              Girls Varsity Swimming               August 23, 2010       High School Pool                     8:30 AM
              Girls Varsity Tennis                 August 24, 2010       High School Tennis Courts            9:30 AM
              Varsity and JV Boys Volleyball       August 23, 2010       High School Gymnasium                11:00 AM
              Varsity and JV Girls Volleyball      August 23, 2010       High School Gymnasium                8:30 AM

              Modified Football                    August 23, 2010       High School Cafeteria                8:30 AM
              Modified Boys Soccer                 September 1, 2010     Bus Garage Field                     5:00 PM
              Modified Girls Soccer                September 1, 2010     GLP Field                            10:00 AM
              Modified Boys Volleyball             September 1, 2010     GLP Gymnasium                        9:00 AM
              Modified Girls Volleyball            September 1, 2010     Main St. Gymnasium                   9:00 AM
              Modified Field Hockey                September 1, 2010     High School Field Hockey Fields      9:00 AM

              Selective Classification Testing     August 26, 2010       High School Track                    12:30 PM
                                                                    EDEN CENTRAL SCHOOL DISTRICT
                                                                          3150 Schoolview Rd.
                                                                         Eden, New York 14057
   Ronald Buggs, Superintendent                                                                                            Shawn Johnson, Director of Pupil Personnel Services
        (716) 992-3629                                                                                                                         (716) 992-3645
                                                                       HEALTH APPRAISAL FORM
Name:                                                                                                     Date of Birth:
School:                                                                  Gender:    M F                 Grade:

                                                                     IMMUNIZATIONS / HEALTH HISTORY
 Immunization record attached                                                  Sickle Cell Screen:  Positive                   Negative        Not done Date:
 No immunizations given today                                                  PPD:                 Positive                   Negative        Not done Date:
 Immunizations given since last Health Appraisal:                              Elevated Lead:       Yes                         No             Not done Date:
                                                                                Dental Referral      Yes                         No             Not done Date:
Significant Medical/Surgical History:  See attached

Specify current diseases:                               Asthma              Diabetes:  Type 1         Type 2                Hyperlipidemia                      Hypertension
                                                        Other:
Allergies:       LIFE THREATENING                      Food:                             Insect:                                   Other:
                 Seasonal                              Medication:

                                                                                   PHYSICAL EXAM

Height: _______________                 Weight: _______________               Blood Pressure: _______________                              Date of Exam:
Body Mass Index:        ____ ____ . ____                                                 Vision - without glasses/contact lenses             R              L
Weight Status Category (BMI Percentile):                                                 Vision - with glasses/contact lenses                R              L
 less than 5 th
                           5 through 49
                             th            th
                                                        50 through 84
                                                             th              th
                                                                                         Vision - Near Point                                 R              L
 85 through 94
     th            th
                           95 through 98
                                  th            th
                                                         99 and higher
                                                                                         Hearing  Pass 20 db sc both ears or:               R              L

 EXAM ENTIRELY NORMAL                                             Tanner:    I.   II.      III.    IV.      V.       Scoliosis:    Negative  Positive:
Specify any abnormality (use reverse of form if needed):

Medications (list all):                 None          Additional medications listed on reverse of form

Name: ____________________________________________________ Dosage/Time: ______________________________________________________________

Name: ____________________________________________________ Dosage/Time: ______________________________________________________________

If AM dose is missed at home: _____________________________________________________________________________________________________________
I assess this student to be self-directed  Yes  No                      Student may self carry and self administer medication  Yes  No
               Note: Nurse will also assess self-direction for the school setting. Please advise parent to send in additional medication in the event that emergency
                                                 sheltering is necessary at school or if the morning medication has not been given.

 Free from contagions & physically qualified for all physical education, sports, playground, work & school activities OR only as checked:
___ Limited contact: cheerlead, gymnastics, ski, volleyball, cross-country, handball, fence, baseball, floor hockey, softball.
___ Non-contact: badminton, bowl, golf, swim, table tennis, tennis, archery, riflery, weight train, crew, dance, track, run, walk, rope jump.

 Restrictions:                                                                                                                                          Please monitor

 Protective equipment required:                      Athletic Cup            Sport goggles/impact resistant eyewear           Other:
                                                                                                                                                                (Stamp below)
Provider’s Name/Address:                                                                                  Phone:

                              _________________________________________                                   Fax:

Provider’s Signature:                                                                                     Date:

This exam complies with NYSED requirements and is valid for twelve months. NYSED requires an annual physical exam for new entrants, students in
         Grades K, 2, 4, 7 and 10, sports, working permits and triennially for the Committee on Special Education.           Rev. 10/3/07

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