Athletic Training Forms

Dear Student Athlete,

In order to facilitate your participation in athletics here at Trinity Christian College, we have put together some information for you and your parents concerning requirements for insurance and physicals. These items require your immediate attention and must be received by the Athletic Department no later than August 1, 2012.

  1. Parent/Guardian/Student Information Form – This must be filled out in its entirety.
  2. Insurance Card - Please include a FRONT and BACK copy of your primary medical insurance card. I would also recommend that each student-athlete return to school with his/her own insurance card.
  3. Physical Forms - Trinity will no longer be paying for athletic physicals for our athletes, but you are required to obtain a physical before participating in your sport. When obtaining a physical from your physician, please be sure the physician completes either the form provided or a physical document utilized by his/her office.
    1. Any student-athlete evaluated for an injury and/or medical condition which required physician evaluation, treatment, and/or additional referral must be cleared by the treating physician. A physical alone will NOT be accepted as clearance for return to play. The student athlete MUST be cleared by the physician who has medically evaluated and treated the injury and/or medical condition. Failure to obtain specific clearance for said injury/medical condition will result in restriction of athletic participation until appropriate documentation is submitted to the Athletic Department/Head Athletic Trainer.
    2. A physical will not be accepted as complete until the physician indicates “cleared without restriction” on the form and provides his/her physician signature, office contact information, date and office seal/stamp.
  4. Athlete Questionnaire Form – Please be sure this document is completed by you in its entirety.
  5. COMPLIMENTARY Secondary Insurance Policy – This form explains the Secondary Athletic Insurance Policy purchased by Trinity Christian College which is provided to all student-athletes. The form must be read, signed and dated by both parent and athlete.
  6. Acceptance of Risk/Liability – This form must be read, signed and dated by both parent and athlete.
  7. Consent to Treat/Authorization for Release of Medical Information – This form must be read, signed and dated by athlete. If an athlete is a minor, Parent/Guardian signature must also be obtained.
  8. Concussion Protocol – This form must be read, signed and dated by the athlete.

Check List:

  1. Parent/Guardian/Student Information Form
  2. Copy of insurance card (both front and back)
  3. Physical Form- 2 pages
  4. Athlete Questionnaire Form – 3 pages
  5. Secondary Insurance Policy – signed by both parent and athlete
  6. Acceptance of Risk/Liability – signed by both parent and athlete
  7. Consent to Treat/Authorization for Release of Medical Information
  8. Concussion Protocol

ALL documentation for EVERY student-athlete must be received by the Athletic Department no later than August 1st, 2012. If all of your documents are not on file, you will be withheld from participation in practice and competition.

I hope you find the material in this packet helpful. See you in the fall!

Sincerely,

Jennifer Luchene, ATC
Head Athletic Trainer
Trinity Christian College
6601 W College Dr.
Palos Heights, IL 60463
P: 708-239-4774