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Pre-Participation / Physical Process

For all new students, freshman & transfers:

Please read through this page thoroughly!

Congratulations on your decision to continue your collegiate career at Kutztown University for 2014-15. We wish you the best for a safe and successful season. At this time we would like to begin to work on the "safe" part of your season.

Below are ALL of the medically-related forms that MUST be completed before you can be cleared to participate in any official Kutztown University Intercollegiate Athletic activity. Please read the Procedures Regarding Athletic Participation, Injuries, Illness and Medical Care. Please read thoroughly the information presented in these forms and fill out completely.

Remember to: submit ALL requested materials; sign and date each form; return all completed forms no later than the indicated return date below.

Reminder that ALL New Student-Athletes will get a Pre-participation Physical Exam at Kutztown University on a specific date & time. Please Check with your Teams Head Coach for that specific date and time.

It is extremely vital that you return all of the requested forms and requested materials by the return date listed. This allows the Sports Medicine Staff time to review the information and contact individuals if necessary. Failure to do so will delay your ability to receive a physical and subsequent participation in Kutztown University Athletics at the earliest opportunity.

*Questions*

If you have any questions regarding the Sports Medicine forms or procedures, please contact Faculty Athletic Trainer, Jack Entriken, via email at entriken@kutztown.edu

 

RETURN DATE:

All Sports: July 1-15


Mail all forms & related correspondence to:

    Kutztown University of PA
    Attn: Athletic Physical Info-New
    Health & Wellness Services
    PO Box 730
    Kutztown, PA 19530.

 

NOTE:   

Please DO NOT fax documents.

Please complete the forms and MAIL them ASAP so they are received prior to the Deadline date.

 

The following is a check list of required forms

         1.  Athletic Medical History Form

                   a. NCAA ADHD/ADD form (ONLY if diagnosed with ADD/ADHD)

         2.  Athletic Insurance Information Form

         3.  Medical Bills Letter of Responsibility Form

         4.  Medical Disclosure Form

         5.  Medical Consent/Release Form

         6.  Student-Athlete Injury & Illness Acknowledgement Form

         7.  Sickle Cell Trait Reporting Form (NCAA Policy)

 

The following forms are to be completed online for Health & Wellness Services**

         8.  Required Medical Forms for Health & Wellness Services

 

 

Adobe Acrobat Reader

(Click here to download/update the most recent version of this program)

 

1.  Athletic Medical History Form (Click here for required form)

NOTE: Please submit the form by the deadline, even if you don't have all of the requested medical documentation. You will be asked to supply that information prior to your physical.

IMPORTANT NOTICE:

ONLY for those students who have been diagnosed with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder

If you have been diagnosed with ADD/ADHD here are the NCAA Guidelines for Reporting Treatments for ADD/ADHD, which is required annually.

(click her for the required form)

2.  Athletic Insurance Information Form

(You MUST type in all information before printing. Hand written forms will NOT be accepted as complete.)

NOTE: Please mail the original with a 'legible' copy of your insurance card taped to the form in the appropriate boxes.

Please read the Policies & Procedures Regarding Athletic Participation, Injuries, Illnesses and Medical Care. Click here to open the document.

 

3.  Medical Bills Letter of Responsibility Form

4.  Medical Disclosure Form

5.  Medical Consent/Release Form

6.  Student-Athlete Injury & Illness Acknowledgement Form

SPECIAL ALERT!

It is Mandatory that all KU Student-Athletes go to this web-page to review additional concussion education items and complete the Student-Athlete Injury Illness Acknowledgement Form.

Click on the following link:

"Concussions in Collegiate Sports:  An Overview of Facts, Policy, & Practice"

 

7.   Sickle Cell Trait Reporting Requirement (Click here)

 

IMPORTANT Note:  All prospective student-athletes will receive a physical by Kutztown University’s designated physicians. Physicals received from family (home) physicians will NOT be accepted.

Mail all forms & related correspondence to:

    Kutztown University of PA
    Attn: Athletic Physical Info-New
    Health & Wellness Services
    PO Box 730
    Kutztown, PA 19530.


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8.
 Required Medical Forms for Health & Wellness Services

IF THIS IS YOUR FIRST SEMESTER AT KU, PLEASE READ BELOW FOR ADDITIONAL HEALTH & WELLNESS SERVICES REQUIREMENTS THAT WILL AFFECT YOUR ABILITY TO PRACTICE!!!

     -You will receive directions in the mail to complete the Required Medical Forms for Health & Wellness Services. Make sure you complete the two-step process.

      Click here for details.

      NOTE: 

     -These forms MUST be completed in addition to the forms required by Sports Medicine by August 1.