SAMPLE                                                       

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

 

SPINAL SCREENING NOTICE

 

Dear Sixth Grade Parents,

    

XYZ Charter School will conduct a spinal screening for the 6th graders on______________________.  According to state law, all children in grades 5 or 6 are required to be screened, and we will provide this service for our students at no charge.

 

The purpose of spinal screening is to detect the signs of any abnormal curvature of the spine at its earliest stage so that the need for treatment can be determined.  Scoliosis, a common spinal abnormality found in adolescents, is a sideways twisting of the spine.  It is usually detected in children between the ages of 10 and 14.  Kyphosis, sometimes called round back, is an exaggerated rounding of the upper back and is often confused with poor posture.  Many cases of curvature of the spine are mild and require only observation by a physician when they are first diagnosed.  Others can worsen with time as the child grows and require active treatment such as bracing and surgery.  Early treatment can prevent the development of severe deformity that can affect a person’s appearance and health.

 

The procedure for screening is simple.  A medical doctor, with a nurse in attendance, who has been specially trained, will look at your child’s back while he/she stands and then bends forward.  For this examination, boys and girls will be seen separately and individually.  Boys can wear their uniform shorts, but will need to remove their shirts.  Girls are requested to wear a halter top and shorts or a two-piece bathing suit under their uniform.  Parents will be notified of the results of the screening ONLY if professional follow-up is necessary.  This screening procedure does not replace your child’s need for regular medical checkups.

 

Please sign and return the form below to the teacher by _______________.  We hope you will make every effort to have your child present on that day.  We appreciate your help and cooperation.  For additional information please call ________________________.

 

                                                                        Sincerely,

 

                                                                        Chief Education Officer

 

Cut here and return bottom portion of the form.  Save top portion for your records.

 

  • I give permission for my child, _____________________________________, to receive the free spinal screening at school on ____________________________.
  • I will have my child, _____________________________________________, screened by a family physician, and will submit the results, signed by the doctor, to your office no later than _______________.
  • I do not wish to have my child, _____________________________________, screened for religious reasons and will submit an affidavit of exemption to the school office no later than __________________.

 

______________________________________________   _______________________________

Parent Signature                                                               Date

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