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New Students Athletes 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 2017-18.  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. For questions regarding the Policies and Procedures for Athletic Participation, Injuries and Medical Care, please Click Here.

Attached are ALL of the Athletic Medically-Related forms that MUST be completed before you can be cleared to participate in any official Kutztown University Intercollegiate Athletic activity. Please read thoroughly the information presented in these forms and fill out completely.

Remember to: Submit ALL materials; sign and date each form; return all completed forms no later than the deadline. This allows the Sports Medicine Staff time to review the information and contact individuals, if necessary. Failure to do so will delay participation in Kutztown University Athletics.

Deadline to return forms:    July 17th, 2017

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.

NOTE:
Please
DO NOT fax documents.

Print single-sided and complete ALL forms NO LATER THAN JULY 17th and mail them UNFOLDED to:

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

The following is a check list of required forms:

      Athletic Medical History (4 pages)
      Athletic Physical (1 page) (completed by family MD, DO or CRNP {Nurse Practicioner} only)
      NCAA ADHD/ADD form (ONLY if diagnosed with ADD/ADHD) (1 page)
      Athletic Insurance Information Form (Type info in document BEFORE Printing)(1-2 pages)
                      Attach a copy of the Front & Back of Insurance card after printing as directed
      Medical Bills Letter of Responsibility form (1 page)
      Medical Disclosure Form (1 page)
      Medical Consent/Release Form (1 page)
      Student-Athlete Injury & Illness Acknowledgement Form (1 page)
      Sickle Cell Trait Reporting Form (NCAA Policy) (see instructions for submitting)

Please Click Here to Open and Print / Download Forms



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SPECIAL ALERT!

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

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

 In response to the NCAA's efforts to help institutions educate about and manage concussions in sport, Kutztown University Sports Medicine Services and Intercollegiate Athletic Services is providing the following education to our student athletes.

Please watch the Video on Concussions: Don't Hide It, Report It, Take Time to Recover, and read the 'Fact Sheet for Student-Athletes on Concussions,'

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 The f ollow ing f orms ar e to be co mple ted 'online' for Health & Wellness S ervices**

          Required Medical Forms for Health & Wellness Services

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


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