Health Form Information 2019 – 2020

Click here to read the instructions for completing the Health & Emergency Form Instructions.

There is an additional note in the instructions for students who are participating in athletics.

Click here to download a PDF of the 2019 – 2020 Health Form

Health/Emergency Form is due on or before July 29, 2019


The Health/Emergency Form MUST BE COMPLETED EACH ACADEMIC YEAR by both a parent AND physician.

Please do not submit a different physician form or attachment.   

Information requested must be ON THIS HEALTH/EMERGENCY FORM ONLY – No copies or faxes accepted

We use this form throughout the year for off-campus activities, including sports teams, overnight field trips and Enrichment Week. The 2017-2018 Health/Emergency Form must be returned on or before July 29, 2019 to fulfill each student’s registration requirements.

To comply with state law, students must have this form on file with the Registrar every academic year whether or not they are participating in a sports program.

A few insights and suggestions:

If your child has not had a physical within the last two years, make an appointment now to ensure compliance with the July 29, 2019 deadline. Physicians will not complete and sign this form if your child has not had a physical examination within the last two years.

 If your child has had a physical within the last two years, check with your physician’s office. Most doctors will usually complete and sign the Health/Emergency Form without a visit.  However, if your child plans to participate in sports, they must have a full physical each year. If you have Kaiser coverage, plan ahead as experience has shown that they usually take a minimum of two weeks to process the form.

BE SURE TO MAKE A COPY of the completed Health/Emergency Form before submitting it to the Registrar.

Submit the Health/Emergency Form to the Registrar.


Your child will NOT be considered fully registered or able to participate in a sport if there is not a completed form on file with the Registrar.

Students who do not have a fully completed Health/Emergency Form on file by July 29, 2019 will not be allowed to attend classes beginning August 30, 2019 until it is received by the Registrar.

Please feel free to call Carol Balding, Registrar, at (510) 559-6214 if you have any questions regarding the Health/Emergency Form.