To Parent(s)/Guardian(s):
As part of a required school health examination, a student is weighed and his/her height is measured. These numbers, along with the student’s birth date, are used to determine the student’s body mass index or “BMI”. The information may be sent to New York State Department of Health to help health officials develop programs that make it easier for children to be healthier. The BMI helps the health care provider know if the student’s weight is in a healthy range, is too high, or too low.

Only summary information is sent. No names and no information about individual students are sent. You may choose to have your child’s information excluded from this survey report.

If you do not wish to have your child’s weight status group information included as part of the Health Department’s survey this year, please fill out the form below.
Body Mass Index Opt Out Form

Please do not include my child's weight status information in this year's School Survey. 

Child's Name        Date: 

Parent's Name    Email: 


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