New Student-Athletes, Freshmen, & Transfers

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 2019-20.  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 15, 2019

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)

____Mental Health Screening (1 page) (completed by family MD, DO or other appropriate HealthCare professional)

_____Athletic Physical (1 page) (completed by family MD, DO or CRNP {Nurse Practitioner} 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

Adobe Acrobat Reader 
(Click Here to download/update the most recent version of this program)

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

          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