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Messiah AT: Required Forms for Athletes


Dear Athlete and/or Parent,

The athletic training staff at Messiah College is here to serve the medical needs of our intercollegiate athletes.  In order to facilitate that process, Messiah College and the NCAA require certain forms to be completed prior to the onset of your upcoming sport season.

Required Messiah College Forms:


1) open and complete the following Word forms.

2) save each form to your desktop.

3) email them to AthleticTraining@messiah.edu 

No athlete is permitted to compete or attend a practice until all forms are completed and received .

Forms that must be completed:

                                                 New Athletes    Returning Athletes        Transfers

Athletic Information Form                            X                          X                    X

Amenorrhea questionnaire (women only)      X                          X                    X

Annual Health Questionnaire                                                    X                    X

Insurance Awareness Form                          X                                                X

Athletic Training Services Form                    X                                                X

Consent Form                                             X                                                X

If you are not 18 during any portion of your sport season, your parent/guardian must sign the consent form as well.

Required College and NCAA forms:

All FIRST TIME (e.g., Freshmen) student athletes must have a physical exam performed by a physician and complete a Health History Form.  These forms can be found on the Engle Health Center webpage. Returning athletes DO NOT need a physical from a physician since you've already received a physical upon entering college.

The NCAA mandates that all 1st time college athletes receive a physical exam within six months of the start of your traditional or non traditional season.  To avoid having to get two physical exams please wait until  May 1 before getting your exam.  Mail your completed Health History and Physical Exam forms to the Engle Health Center no later than August 1 so that it can be reviewed and forwarded to the athletic training staff.  Please understand that without these forms you cannot practice or compete.  Schedule early to avoid any issues with getting a physical exam.

What if I get injured while participating in intercollegiate sports?

If you need medical care that results in medical expenses refer to the insurance checklist form to guide you though the process of making sure proper paper work is completed.

Medical bills will be the paid by the student-athletes primary insurance carrier (mom/dad’s policy). The College athletic accident insurance is a secondary policy and takes effect after bills have been sent to your primary insurance carrier. If you are independent and have no other insurance coverage, the College athletic accident policy serves as your primary insurance. Please be aware that Messiah College does not pay for any athlete medical expenses. The athlete's priamary insurance and athletics secondary insurance coordinate to pay appropriate injury medical expenses.  In some cases, the athlete and/or parents may have out-of-pocket medical expenses.

Should you get hurt and need medical attention.  Seek out an athletic trainer to fill out an Athletic Accident Insurance form so the insurance company can be made aware of your injury and future bills that you or your parents will be sending them. The insurance company requires this form to be completed within 90 days of your injury.

Athletic accident insurance is not the same as the school (Engle Health Center) health insurance that all students have the option to purchase. The athletic accident insurance is provided for you free of charge but is limited to sport injuries and takes effect after your primary insurance has paid its portion of the bill. Coverage by this policy is limited to sport injuries occurring during official practices, games and travel to and from such.  It does not cover training on your own or captain lead practices, nor does it cover overuse injuries or the medical bills associated with them. In order to make use of this secondary policy, it’s important that you follow the instructions on this checklist as well as on the Insurance Awareness Form.

We look forward to working with you.


Messiah College Athletic Training Staff


Messiah College Athletic Trainers

Sandy Bush

Women's Soccer, Men's and Women's Swimming, Women's Lacrosse, Men’s Tennis


Wendy Cheesman

Women’s Tennis, Field Hockey, Women’s Basketball, Men's Lacrosse, Golf


Brenda White

Men’s Soccer, Wrestling, Indoor Track & Field, Outdoor Track & Field


Jeremy Kauffman

Men's and Women's Cross Country, Women's Tennis, Men’s Basketball, Baseball, Golf


Retta Murray


Other important forms
Medical Advisor’s Report
Bring a Medical Advisor's Report Form with you when you seek the  care of a physician. Have the doctor complete this form specifying any specific restrictions, return to play dates, rehabilitation instructions, etc. and return the form to your supervising athletic trainer. Having written instructions from a physician expedites your return to play as it helps the athletic training staff provide you with the best possible care and eliminates heresay information by having all instructions in writing. Note: these forms are available at the Athletic Training Room as well as the Engle Health Center.

Seeing a physician and getting reimbursed for expenses

ACI Insurance Co. Claim Form
If you are injured during athletic practices or games in which a coach is present and are referred to a physician for further care you must fill out this form.  Administrative Concepts Insurance provides Messiah College athletes with secondary care that may provide reimbursement after your primary insurance company (your parent’s insurance company) pays their portion.  Please see the athletic training staff to help complete this form. They will help you, but this is ultimately your responsibility to see that it is completed.  You can find guidance in working through the billing/reimbursement process by referring to this link.