The College of Mount St. Joseph will host the Fifth Annual High School Athletic Training Workshop on July 16-17, 2008. For more information and the registration form, please see the link in the right-hand column.
-------------------------------------------------------------------------------------------------------------------------
NEW FOR THE 2008-2009 SCHOOL YEAR
(forms located on the right-hand side of this page)
ALL STUDENT-ATHLETES MUST PRINT AND COMPLETE THESE FORMS. COPIES WILL NOT BE PROVIDED AT THE TIME OF PHYSICALS!
FRESHMEN AND OTHER FIRST-TIME PARTICIPANTS MUST COMPLETE:
- Medical History form—Please be as complete and accurate as possible
2. Insurance Information form—Please complete so we may expedite the scheduling of physician appointments for our student-athletes. Please include a copy of all insurance card, front and back, with the completed form. The College of Mount Saint Joseph carries a secondary athletic accident insurance policy. Please see the Student Athlete Athletic Training Handbook for more information regarding our secondary insurance policy.
- Personal Information form
4. Risk Waiver form
- All Release forms
Release to ATS: This form allows the student-athlete to work with our Athletic Training Students in our accredited Athletic Training Education Program. Each sport is assigned students to assist the Certified Athletic Trainer with the daily routine of handling athletic injuries
Release to Coaches: This form allows the Certified Athletic Trainer to inform the coaching staff of injury and/or illness that may prevent the athlete from participating in a game or practice.
Release to Parents: This form allows the Certified Athletic Trainer to inform the athlete’s parents of an injury and/or illness that may prevent an athlete from participating in a game or practice.
Release to Teammates: This form allows the athlete to be treated in the athletic training room while other teammates, or members of other teams, are present. This is the normal, daily routine of the athletic training room. The Athletic Training staff will not be offering information to your teammates.
6. Insurance HIPPA—This form will permit us to release medical information to our secondary insurance carrier should an injury occur and documentation of the
injury is requested by the insurance carrier in order to process bill payment.
7. NCAA HIPPA—Allows the College of Mount Saint Joseph to release health
information to the NCAA, if required
8. Handbook Signature Page
9. Privacy Practices
ALL RETURNING STUDENT-ATHLETES MUST COMPLETE:
- Medical History Update form—Please be as complete and accurate as possible.
2. Insurance Information form—Please complete so we may expedite the scheduling of physician appointments for our student-athletes. Please include a copy of all insurance card, front and back, with the completed form. The College of Mount Saint Joseph carries a secondary athletic accident insurance policy. Please see the Student Athlete Athletic Training Handbook for more information regarding our secondary insurance policy.
3. Personal Information form
4. Risk Waiver form
5. Insurance HIPPA—This form will permit us to release medical information to our
secondary insurance carrier should an injury occur and documentation of the
injury is requested by the insurance carrier in order to process bill payment.
6. NCAA HIPPA—Allows the College of Mount Saint Joseph to release health
information to the NCAA, if required
7. Handbook Signature Page
Additionally, if you have had any major injuries and/or illnesses within the last two years, it is required that you obtain and forward, to the following address, all records (x-ray, MRI, doctor, hospital, physical therapy, surgery reports, etc) regarding the injury and/or illness. Doing so will make your pre-participation examination (PPE) a much smoother experience. PPEs are scheduled for August 13th for football, August 16th for all fall sports and August 23rd for all winter and spring sports. PPEs are mandatory to be eligible for practices and competition. Please contact the Athletic Training or Athletic Departments for exact times.
Please return all information and completed forms to:
Lisa Osterbrock
Head Athletic Trainer
College of Mount Saint Joseph
5701 Delhi Road
Cincinnati, OH 45233
Or, you may drop off your completed forms to the Athletic Training Room or Athletic Department at your leisure.
These forms are not substituted for other requirements (i.e. insurance, pre-admittance physical, etc) for registration at the College.
FAILURE TO COMPLETE ALL OF THE APPROPRIATE FORMS WILL PRECLUDE YOU FROM PARTICIPATION IN ATHLETICS AT THE COLLEGE OF MOUNT SAINT JOSEPH UNTIL THEY ARE COMPLETED.