HILBERT COLLEGE SPORTS MEDICINE
HEAD ATHLETIC TRAINER: OPEN
TEAM PHYSICIAN: DR. JENNIFER TEETER, D.O.
OFFICE PHONE (716) 926-8806
OFFICE FAX (716) 649-6429
ADDRESS HILBERT COLLEGE
5200 SOUTH PARK AVE.
HAMBURG, NY 14075
Pre-Participation Physical and Waiver Forms
Before beginning participation in Hilbert College Athletics each student-athlete must download and complete the Hilbert College Athletics Pre-Participation Physical and Waiver Form with the signature of their primary care physician
· Freshman who will be living on campus must have their primary care physician sign both the residence life physical evaluation form and the Hilbert Athletics Pre-Participation Physical.
· The residence life form must be returned to Hilbert College.
· The Athletic Pre-Participation Physical form should be brought to initial pre-season meeting or Fall team meeting.
· Physicals must be dated NO EARLIER THAN APRIL before the beginning of the fall semester.
LINK TO PRE-PARTICIPATION PHYSICAL (PDF file):
Page 1-3: Pre-Participation Physical Examination
· NCAA Regulations mandate that each student athlete must submit a Pre-Participation Physical Exam each year.
· Must be obtained no earlier than April before the beginning of the school year.
· Should be completed and signed by the student-athletes primary care physician during yearly physical examination.
Page 4: Participation and Insurance Waiver
· Participation and insurance waiver should be completed and returned with a copy of the of the student-athletes health insurance card Front and Back.
· Please Note that each student athlete must have primary health insurance in order to participate in Hilbert College Athletics.
· Student health insurance plans are available at a cost to the student. Please contact Residence Life for more information.
Page 5: Declaration of Medication
· Please list ALL prescription medications that the student athlete is taking.
· The NCAA bans performance enhancing drugs to protect student-athlete health and safety and ensure a level playing field, and it also recognizes that some of these substances may be legitimately used as medications to treat student-athletes with learning disabilities and other medical conditions.
· Accordingly, the NCAA allows exceptions to be made for those student-athletes with a documented medical history demonstrating the need for regular use of such a drug.
· Exceptions may be granted for the following classes of banned drugs: stimulants, beta blockers, diuretics, anti-estrogens, anabolic agents, and peptide hormones.
· Student-athletes taking medications to treat ADD/ADHD will be particularly affected. The NCAA requires student-athletes taking stimulant medications for the treatment of ADD/ADHD to provide adequate documentation of diagnosis and treatment plan to qualify for a medical exception. Therefore, if you are taking any medications banned by the NCAA you MUST provide documentation from the treating physician, outlining in specific detail the diagnosis, treatment plan and medications, to the Hilbert College Sports Medicine PRIOR to participation in your chosen sport.
· For more information on this NCAA requirement please visit the NCAA Health & Safety website.
Page 6: Sickle Cell Testing Waiver
· In accordance with the NCAA recommendation, we encourage all students to be tested for Sickle Cell Trait if they have not already been tested. Knowing your Sickle Cell Trait status is helpful information for the Sports Medicine staff.
· Please ask your physician to verify your status for the trait during your physical and sign the waiver accordingly.
· If your status for the trait is unknown, arrange for a test through your physician or sign the box requesting Hilbert College to arrange a test for you (at the expense of the student-athlete).
· Only Freshman and Transfers must complete this form