ࡱ > h j g bjbj . e e | | d f f f f f f $ | X X X X d X d ö( b P 0 l D q ^ L = Z X X X X | : . Dear Parent/Guardian of a 10th Grade Student; As part of a required school health examination, a student is weighed and his/her height is measured. These numbers are used to figure out the students body mass index or BMI. The BMI helps the doctor know if the students weight is in a healthy range or is too high or too low. New York State Education Law requires that BMI and weight status group be included as part of the students school health examination. A sample of school districts will be selected to take part in a survey by the New York State Department of Health. If our school is selected to be part of the survey, we will be reporting to NYS Department of Health information about our 10th grade students weight status groups. Only summary information is sent. No identifying information about individual students is sent. However, you may choose to have your childs information excluded from this survey report. The information sent to the NYS Department of Health will help health officials develop programs that make it easier for children to be healthy. If you do not wish to have your childs weight status group information included as part of the Health Departments survey, please print and sign your name below and return this form to Phyllis Cobb at CHHS Health Services. If you have any concerns regarding your childs weight status please discuss it with your health care provider. If you have any questions regarding the NYS Health Department survey please call Phyllis Cobb at 271-6935. BMI/WEIGHT CATERGORY SURVEY OPT OUT If you DO NOT wish to have your childs weight status group information as part of the Health Departments survey this year, please print and sign your name below and return this form to: Phyllis Cobb, R.N. Health Services Croton-Harmon High School 36 Old Post Rd. South Croton-on-Hudson, NY 10520 Please do not include my childs weight status information in the 2008-2009 School survey. ___________________________ _______________________________ Print Students Name Date ___________________________ ________________________________ Print Parent/Guardians Name Parent/Guardians Signature & * 9 | } ! , S U U X ) * + $ G H S U V Y Ž h97 h~ >*h~ 5>* h~ 5hK h~ 5hK hK 5h- h97 h]' >*h h H*hul] h h hK6J j hK6J Uh]' h~ , : ; J K + , ! " # &d P gd- # $ H I J K L 0 L d < = > ? &d P gd~ ^`gd~ gd~ gdK ? @ ~ gd~ , 1h/ =!"#$%