As part of a required school health examination, a student is weighed and his/her height is measured. These numbers are used to determine the student’s body mass index or “BMI.” The BMI helps the doctor or nurse know if the student’s weight is in a healthy range or is too high or too low. Recent changes to the New York State Education Law require that BMI and weight status group be included as part of the student’s 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 the NYS Department of Health information about our students’ weight status groups. Only summary information is sent. No names and no information about individual students are sent. However, you may choose to have your child’s 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 healthier. If you do not wish to have your child’s weight status group information included as part of the survey this year, please print out this page, sign and print your name and return the form to: Nurse Donna Lenz at 3800 North Main St., Holley, NY or email@example.com.
Please do not include my child's weight status information in the 2018-19 School Survey.
Print Child's Name Date
Print Parent's Name Parent's Signature
Click the link at right for the Spanish version of this form.
Click the link at right for more information on BMI from the CDC website.