2019-20 Enrolled Student Medical Forms
Welcome, new families! The following summarizes the important health forms and other enrollment requirements for the 2019-20 school year along with contact information should you have any questions. The first major deadline among these is June 3.

We look forward to your arrival on the Hilltop in September!
Please read:  Reminders and Requirements from the Health Office

Physical Evaluation and Medical History dated in the year 2019 and submitted by JUNE 3, 2019.
  • All NEW students
  • All BOARDING students
  • All students entering Grades 5 and 9
  • All students in Grades 7-12 participating in Interscholastic Athletics
  • Returning students: If you are unable to provide a current physical by JUNE 3, 2019 due to insurance purposes, you can submit a copy of the last physical along with immunization records to the health office- if you have not already done so. As soon as your child has received an updated physical and/or immunization please forward that information to the health office.
Updated Immunization Records dated in the year 2019 and submitted by JUNE 3, 2019.
  • ALL STUDENTS K-12 
  • ALL NEW and BOARDING
Medication Permission Form submitted by JUNE 3, 2019.
  • All students for whom families would like the school nurse to have permission to administer prescription or over-the-counter medication (NO EXCEPTIONS)
Eye Examination Form
  • Recommended for all new students. (As many as 25% of children have vision problems that are not diagnosed by their pediatrician.)
Note: Please retain a copy of the completed health form for your records. Make sure that the physician signs and dates all necessary forms. If applicable make sure the physician clears your child for athletics/physical education.

Questions? Please contact:

Shannon Schlifkin, RN
School Nurse
(914) 366-2647
sschlifkin@hackleyschool.org

In July and August, please contact:
Janice Starace
Infirmary Administrative Assistant
(914) 366-2647
jstarace@hackleyschool.org

Forms can be faxed to (914) 631-3372