ICSB Permission for Annual Physical Examination
Dear Parents, Our school doctor, a pediatrician, would like to offer a comprehensive screening during our annual physical exams. These changes are intended to improve our services in monitoring the overall health, growth and development of your child. Every student at ICSB will be given the standard physical which is required by law. This includes checking height, weight, blood-pressure, heart, lungs, abdomen, throat, ears, bones, muscles, neurology, vision and dental. We offer, at no extra charge, a more extensive exam as well as education in breast and genital health. This is a developmental screening for your child to detect any hormonal or growth issues that may be occurring. Many types of cancers go untreated because education has not been done to make early detection possible. By educating your child regarding testicular and breast cancer, they will then have the knowledge to do this themselves and possibly prevent the progression of these diseases by early detection. If the result of this screening is abnormal, we will notify parents. Please read and complete the form below to complete this step of the re-enrollment process. Thank you for your patience and understanding. ICSB Health Office Lenee Oakley, Melinda Tatar and Újlakiné Pándi Emőke
By Checking the Box Below, I understand that my child will receive the Standard Physical required by law for all children in all schools. I understand that if I choose not to have ICSB perform the physical examination, I am required by law to have another doctor perform the examination and will need to provide ICSB with the required medical documentation!
LEGAL AGREEMENT
	I understand and agree.
STUDENT NAME(S)
List your Student('s) name(s) below that these permissions will apply to. (List in the format: Lastname1, Firstname1; Lastname2, Firstname2; ....)
Student Name
Permissions
I give ICSB school doctor permission to perform the physical exam on my children.
	YES, I Give Permission
(Remember, if you do not check the box above, you will need to have your doctor perform the tests and will need to submit the required documents to the school.)
I would like to be present when the physical examination is performed.
	YES, I would like to be present
I would like to add the genital exam for male students which includes evaluation of descended testicles and if my son is uncircumcised, the retraction of the foreskin.
	YES, also add the genital exam
I would like to be present when the genital exam is performed.
	YES, only with me present
Additional Information
List any special permissions or notes for individual children below:
Thank you for filling out the form. Click the "Submit" button below to finish.

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