Health & Wellness
Child & Adolescent Health Examination Form
We care for the whole child — mind, heart, and body. New York State requires an up-to-date physical examination on file for every student. Please download the form below, have it completed by your child's health care provider, and return it to the school office.
About This Form
This is the official New York City Department of Health and Mental Hygiene / Department of Education Child & Adolescent Health Examination Form (CH205). It records your child's physical exam, immunization history, and any health conditions our school nurse and teachers should be aware of.
Who Needs to Submit One
- Every new student enrolling at St. Mark's Day School
- Students in the grades New York State designates for a periodic physical
- Any student whose most recent exam has expired
How to Submit It
Have your child's doctor complete and sign the form, then return the completed copy to the school office — you may drop it off in person or email it to info@saintmarksdayschool.org.
Download the Form
Child & Adolescent Health Examination Form (PDF)
Download PDFPlease Note
This form must be completed and signed by a licensed health care provider before it is returned to the school.
Questions about this form? Contact the school office at info@saintmarksdayschool.org.