Welcome to Mrs. Lipnitz's Nurse Page

Dear Parents/ Guardians of Incoming 6th Graders,

Hi, my name is Elaine Lipnitz and I am the School Nurse for the Haines 6th Grade Center. This information I’m sharing with you is time sensitive. With the school weeks waning and summer fast approaching the time is now to share this information. As a Nurse who had worked in a busy Pediatric Office for well over 10 years, I understand the necessary time needed for scheduling a pediatric well visit and getting forms completed, so I wanted to give you plenty of notice.

There are three forms you need to be aware of: (there is a link to each form below)

1-      Preparticipation Evaluation Form (Physical Form used for Middle School)

2-      Immunization Requirements for 6th Grade

3-      Medication Authorization Form

1-  Preparticipation Evaluation Form: The physical form is NOT mandatory for your child to enter 6th grade unless your child is new to the district or they wish to play an intramural/interscholastic sport. Students new to Medford Township are required to have a physical form on file in the nurse’s office. In addition, any student who may opt to play an intramural/interscholastic sport  will be required to have a current physical form on file.  As per the State requirements, no other form may be accepted. Please note, physicals are good for ONE YEAR from the date of the examination.  A year after that date they expire and a new physical is required for a child to participate in extracurricular sports.

There are four pages included with the form. The first page is completed by the parent/guardian. The second is also to be completed by the guardian but only if your child requires adaptive/supportive devices to play. The 3rd and 4th page must be completed by a physician. Your physician must sign in THREE areas, STAMP it with the office stamp, and complete ALL boxes.  Failure to complete any of these items will necessitate the form being returned. We can not accept incomplete forms.  All forms are also reviewed by the school physician before final clearance for participation is given. 

2-      Immunization Requirements: As required by the State, any child entering 6th grade must receive TWO mandatory vaccines before they can enter school in September. The two vaccines are: Tdap (tetanus, diphtheria, and pertussis) and the Meningococcal vaccine

These vaccines are traditionally given at the 11-year-old well visit.  Once your child receives the required immunizations, a copy of the vaccination record must be provided to Haines Sixth Grade Center. You may mail the form or drop it off during the summer hours in the Main Office. We highly recommend you keep a photocopy for your own records. 

If your child does not turn 11 years old until after the first day of school, he/she will not be required to have the vaccinations before their 11th birthday. However, he/she will be required to receive them within a week of their birthday.  When you make your child’s appointment, please have the physician forward a note as documentation of the appointment date. 

The State does an annual review of ALL sixth grade student immunization records. We must be 100% in compliance with this mandate.  Therefore either a current immunization record with the required vaccines or documentation of an appointment must be on file for every enrolled student when the State comes to audit the immunization records.

3-      Medication Authorization Form: This form is required for a child needing any daily medications during the school day.  This does not include inhalers and epinephrine auto injectors.  Students who have noted on their health files as having asthma or a life threatening allergy will receive a copy of the necessary forms directly from me at another time.  If you do not receive one and/or need one sooner, please email me and I will be sure to get one to you or you can download one from the link below.

Thank you very much for your attention to this important information.  I know September is still a way off but the last thing anyone at Haines wants to do is exclude your child from the start of school because he/she does not have the mandatory immunizations. 

If you have any questions or concerns, please do not hesitate to contact me through email, [email protected]  or leave a phone message at school.  I check both daily and will get back to you as soon as possible.  

Elaine S Lipnitz, RN, BSN



Medical Forms
Everyone Smiles in the Same Language.
-George Carlin

Haines 6th Grade School Nurse

162 Stokes Road, Medford  

609-654-4056, ext 8534

[email protected]