Medical Forms

The Heichal HaTorah medical forms are available for download using the links below.

These forms can be mailed to our office or emailed to the nurse at

All non-sports forms must be submitted by Thursday, August 25, 2016,  for your son to be admitted to school.

All students require documentation of a physical dated within 364 days of the first day of school.  You may use your healthcare provider’s form or download the Universal Health Form.

All students are required to have a parent fill out the Health Update Form.

All Incoming Freshman and transfer students must submit documentation of immunizations.  Your healthcare provider will provide that form.

Students with asthma and/or allergies
Asthma Action Plan
Allegry Action Form

Any student who will play a team sport ( ie. basketball, not regular physical education ) will require the following forms submitted before the first practice.

  1. Scholastic Student-Athlete Act Guide for Parents ( Read Only )
  2. Preparticipation Physical Evaluation ( PPE )
  3. Preparticipation Clearance Form ( PCF )
  4. Preparticipation History Form ( PHF )
  5. Sudden Cardiac Death Pamphlet ( Read Only)
  6. Cardiac Sign-Off Sheet
  7. Sports-Related Concussion ( Read and Sign )
  8. Sports-Related Eye Injury Fact Sheet ( Read Only )
  9. Health History Update Questionnaire ( Will need to fill out within 90 days of the first practice )

Our school nurse L’via Weisinger RN will be on-site approximately 3 hours a week.  Her primary role will be administrative, to ensure the Yeshiva’s compliance with state and local health and safety regulations.  She is available for consultation concerning the health issues of our students as well as state mandated screenings as needed.  You may reach her at

In case,  of an emergency during school hours, Rabbi Stechler or another administrator will initiate contact with emergency medical services in Teaneck and if necessary your son will be transported to Holy Name Medical Center across the street.  Every effort will be made to contact parents and/or emergency contacts before any decisions are made.