Returning Student Athletes

For all Returning Students:

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 Careplease 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


If you have any questions regarding the Sports Medicine forms or procedures, please contact the Faculty Athletic Trainer who oversees your sport. Click Here for the list of Faculty and team oversight. 

 DO NOT fax documents.

Print single-sided and complete ALL forms NO LATER THAN JULY 15 and mail them UNFOLDED to:

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

The following is a check list of required forms:

_______Mental Health Screen (1 page)(completed by family MD, DO or other Healthcare Professional)

_______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)
              ***This form MUST be submitted if you took the 'Waiver' option last year.  
              You can avoid this by requesting your Newborn Screening Results.

Please Click Here to Open and Print / Download Forms

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

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,'