To:                   All Student-Athletes and Parents

Fr:                    John Ratliff, Athletic Director

                        Robert Merrow, Head Athletic Trainer

Re:                   Athletic Pre-participation paperwork. Physical Exams, Assumption of Risk / Release of information and Health Insurance

It is the policy of the Keene State College (KSC) and the Athletic Department, that all incoming freshman, first year student-athletes or transfer students have a completed health physical form on file in the Athletic Training Department and with the KSC Student Health Services.  NCAA policy requires that these Health physical exams must be current, dated within six months of the student athletes entrance to KSC. Please make sure you have a properly dated physical, in time for the start of your season and return the original KSC  Comprehensive Health and Disability packet and Physical to Student Health Services and mail, email or bring complete copies to the Athletic Training Department as well.  Student-athletes will not be allowed to participate in any practices or games unless current physicals are on hand.  KSC  Comprehensive Health and Disability forms can be downloaded from the KSC Web site under Health Services or the Athletics Web site under Athletic Training links and can be completed electronically.  If you are a returning student-athlete, you do not have to submit a new physical unless your health status has changed due to injury or illness since your most recent sports season, in such case, please bring Physicians documents clearing you for sports participation. 

NCAA Drug testing rules REQUIRE documentation from your Physician for any ADHD medications you may be prescribed.  You must provide the following information in addition to the KSC  Comprehensive Health and Disability packet; Failure to provide this information may affect your ability to participate in any NCAA Post season competition;

1. A record of the medical evaluation for ADHD
2. Statement of the diagnosis, including when it was confirmed
3. History of ADHD treatment (previous/ongoing)
4. A copy of the most recent prescription (as documented by the prescribing physician)

Please complete KSC  Comprehensive Health and Disability packet and clearly indicate which sport(s) you plan to participate in, then mail, email or bring copies to both the Head Athletic Trainer and the Student Health services. 

Health Insurance:  An Important Note To All:

Health Insurance is very important for Student Athletes to have in the event of illness or injury with the need to be treated or have diagnostic tests at a hospital or clinic.  Students at KSC are responsible for their own medical expenses.  Keene State College and the Athletic Department require that students have some form of health insurance, either under your parent(s), guardian(s), or their own personal coverage.  The student is required to maintain coverage while a Student Athlete at KSC.  The KSC Athletic Department carries secondary insurance exclusively for athletically related injuries or illness for Student Athletes.  This insurance provides secondary coverage only, after the first $1,000.00, up to a maximum of $90,000.00, after which the NCAA Catastrophic insurance takes over.  If you accumulate any medical bills not covered by your insurance under $1,000.00, you are responsible for payment.  NCAA policy requires proof of insurance coverage.  Please check with your insurance organization to make sure that the Student Athlete is covered under the insurance plan for any athletic related injuries. Every year please submit a copy of your insurance card, front and back to the Athletic Training department for NCAA verification of insurance.  Student athletes will not be allowed to participate in any practices or games unless this verification is on file with the Athletic Training department each year.

KSC Student Athlete; Pre-Participation Checklist

The following checklist is to ensure that you have completed required information for athletic participation at KSC.  Please take the time to properly complete all requested information.

Returning Student Athletes

• Contact Insurance Company to ensure coverage for athletic related injuries
• SEND, EMAIL, OR BRING  a front and back copy of current insurance card or verification of Insurance coverage on Ins. Co. letterhead.
• If you have had any significant injury over the past year please bring documentation from your Physician clearing you for participation.
• NCAA REQUIREMENT!  Please provide documentation for any ADHD Medications taken on a regularly prescribed basis for a particular reason with supporting evidence and diagnosis from a Medical Practitioner as to the purpose of medication, for NCAA Drug Testing Therapeutic use Exemptions

Upon arrival on Campus for pre season there will be a set time to meet the Athletic Training Staff and:

• Fill  out and sign the Athletic Training department and NCAA required annual sports participation forms
• Complete the Web based Athletic Training information and Health Questionnaire update
• All 3^rd year athletes will complete a second Baseline Concussion screening.
• Any Athletes with current or previous injury that may need an orthopedic or medical evaluation will be seen.  

First Year Student Athletes (freshman and transfers)  Checklist

• Contact Insurance Company to ensure coverage for athletic related injuries
• Make sure you have a current Health Physical (within six months of the start of the semester you begin classes)  and return original to Student Health Services and mail, email or bring a COMPLETE copy to the Athletic Training Department.  rmerrow@keene.edu
• Complete and return original KSC Comprehensive Health  and Disability forms to Student Health and mail, email or bring a COMPLETE copy to the Athletic Training Department.  rmerrow@keene.edu
• SEND, EMAIL, OR BRING  a front and back copy of current insurance card or verification of Insurance coverage on Ins. Co. letterhead.
• NCAA REQUIREMENT!  Please provide documentation for any ADHD Medications taken on a regularly prescribed basis for a particular reason with supporting evidence and diagnosis from a Medical Practitioner as to the purpose of medication, for NCAA Drug Testing Therapeutic use Exemptions.

Upon arrival on Campus for pre season there will be a set time to meet the Athletic Training Staff and:

• Fill  out and sign the yearly Athletic Training department and NCAA required sports participation forms
• Complete the Web based Athletic Training information and Yearly Health Questionnaire update.
• All 1st year and 3^rd year athletes (Freshman and or Transfers) will complete a Baseline Concussion screening.
• Any Athletes with current or previous injury that may need an orthopedic or medical evaluation will be seen.

All medical information is confidential and will be used as an aid to providing healthcare while you are a student-athlete at KSC. Your knowledge and consent is required for release of these medical records.  If the forms are not completed correctly and returned by the beginning of your season your athletic participation at KSC will be delayed.

If you have any questions please contact Bob Merrow, ATC Head Athletic Trainer:  603-358-2824       rmerrow@keene.edu

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