Clifton T. Barkalow Middle School

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Health Office

School Nurse: Mrs. Larisa Ippolito, RN
Phone: (732) 431-4403 Ext: 2108

Welcome to the Barkalow Health Office


6TH GRADE IMMUNIZATIONS:  The NJDOE and the American Academy of Pediatrics have not changed immunization schedules and requirements due to the COVID-19 pandemic. Please contact your pediatrician to discuss scheduling the necessary vaccines.

  • If your child will turn eleven before August 25, 2020 then you must show proof of these immunizations in order for your child to receive their class schedule in September.
  • If your child will turn eleven on or after August 25, 2020, they will receive their 6th grade schedule but they will be excluded from school if the immunizations are not administered within two weeks from their birthday.
This form must be signed by your child’s physician or advanced practice nurse and returned to your current school nurse via e-mail or mailed to the school. After June 15, 2020, forms must be mailed or faxed to your Middle School Nurse.

***If your child will be receiving a physical exam at this time, it is strongly encouraged that you have your child’s physician complete the sports physical packet and scoliosis screening as well. See sidebar for forms.

***Sports physicals must be completed on paper by the parent and the healthcare provider. Completed sports physical packets can be mailed to Barkalow Middle School, 498 Stillwells Corner Road, Attention School Nurse. At this time you will not be able to drop off forms at the school or board office. Completed sports forms are due by August 21, 2020.***

MEDICATION: All medications administered by the school nurse require a physician's order and parental consent form to be submitted to the Health Office.  These must be resubmitted each school year.  See sidebar for forms.  ***Allergy Action Plans are required for life-threatening allergies, ***Asthma Action Plans are required for inhalers (including self-administered).  EpiPens with a dose of antihistamine/Benadryl and inhalers are the only medications that students may carry and self-administer, per New Jersey law.  Please complete a Medication Order form for other necessary medications that will be stored in the Health Office and administered by the Nurse. 

MEDICAL NOTES / EXCUSES: Physician's notes are required to excuse a student from Physical Education class for more than one day.  A parent note is required for a gym excuse for a single day.   Student should bring gym notes to the Health Office when they arrive at school.  Notes must include a length of time that the student is restricted from activity.  Students will not be permitted to return to Physical Education and sports until written clearance is obtained from a physician.

SPARE CLOTHES:  I encourage ALL students to keep a spare set of clothes in their locker. Life happens....and having a spare set of clothes keeps missed class time to a minimum. 

SPORTS PHYSICALS:  ALL SPORTS STUDENTS MUST SUBMIT PAPERWORK TO THE NURSE FOR EACH SEASON (Fall/Winter/Spring) for sports and intramurals. Fall sports include boys soccer, girls soccer, field hockey, cross country, and volleyball (intramural).


You may continue to submit completed sports physicals to the Nurse, as they are valid for 365 days.

Please submit original forms via mail or your child may bring to school.



Exams conducted on or after 9/16/19 are acceptable for the FALL 2020 season. 

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 doctor before they can participate in practice or tryouts. Our school doctor is scheduled in advance to review all the sports physicals for the entire district. Forms that are submitted late or incomplete can not be guaranteed to be approved by the school physician before the season starts. Students who have not received clearance by the school doctor may not participate in any practice or tryout. Please adhere to all deadlines and guidelines to assure that your child is able to participate.


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


  • 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.
  • Incomplete forms will be returned for completion by your health care provider per New Jersey Administrative Code.
  • Exams conducted on or after 9/16/19 are acceptable for the Fall 2020 season.

Complete on Genesis Parent Portal EACH SPORT SEASON

  • Health History Questionnaire

Complete on Genesis Parent Portal ONCE PER SCHOOL YEAR

  • Concussion form
  • Opioid Fact Sheet
  • Sports Related Eye Injuries
  • Sudden Cardiac Death Pamphlet
(See attachment below for Spanish version)
As you are aware, the State of New Jersey has revised the laws regarding school attendance. In order to be in compliance with these laws, the Freehold Township Schools have created board policy to govern student attendance in Freehold Township. A summary of the policy can be found in the student handbook you received in September.

School board policy requires that the school receive a written note for each school absence with the parent's original signature. This note should state the date and reason for absence. We have created a form which may make it easier for you to fill out and send in the required information. You can complete the form in place of a note and return it the day your child returns to school. Immediately following any future absences, you can always refer to this site to access the form or you may write an absence note to your child's teacher. We appreciate your cooperation with this policy.
See Below for Absence Form

CTB Absence Form

Sports Forms
Human Papillomavirus:
Information from the New Jersey Department of Education
Sudden Cardiac Death Brochure