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 the College and the NCAA requires certain forms to be completed prior to the onset of your upcoming sport season.

Please open and complete the following Adobe forms below, save them to your desktop and email them to the athletic trainer assigned to the sport that you will be participating.  If you are an athlete participating in two or more sports please send a copy to all athletic trainers that will be caring for you.  The athletic training staff is listed below, complete with contact information. No athlete is permitted to compete or attend a practice until all forms are completed.

Forms that you must complete:

     Information Form

     Insurance Awareness Form

     Athletic Training Services Form

     Consent Form

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

     Amenorrhea questionnaire (women only)

An insurance checklist form link can be found below. We suggest you read and refer to this should you sustain an injury that requires medical expenses (emergency room, off-campus physician visits, diagnostic tests, etc).  The athletic accident insurance is a secondary policy and takes effect after bills have been sent to your primary insurance carrier. This insurance is not the same as the ‘school health’ insurance that you have the option to purchase as a Messiah College student. Accident insurance is free of charge and provided automatically for all Messiah College athletes, but is limited to accidents and takes effect after your primary insurance as paid its portion of the bill.  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.

Sincerely,

Messiah College Athletic Training Staff

Messiah College Athletic Trainers

Sandy Bush

Men’s Tennis

sbush@messiah.edu

Wendy Cheesman

Women’s Tennis, Field Hockey, Women’s Basketball, Baseball

wcheesma@messiah.edu

Julie Grier

Women’s Soccer, Cross Country, Men’s Basketball, Swimming Men’s and Women’s Lacrosse

jgrier@messiah.edu

Ken Heck

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

kheck@messiah.edu

Retta Murray

Women’s Volleyball, Wrestling, Softball

rmurray@messiah.edu

Other important forms
Medical Advisor’s Report
Prior to seeing any physician that is not a Messiah College physician you must take this form with you.  Have the physician complete this form specifying any specific restrictions, return to play dates, rehabilitation instructions, etc. Return this to your supervising athletic trainer. Having written instructions from a physician expedites your return to play as it helps the athletic training staff provide the best care for you 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.  Bollinger 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.

Required forms for the Engle Center for Counseling and Health Services

Student Health History
This form is required of all Messiah College students prior to attending class.  It must be completed by a physician and returned to the Engle Health Center prior to June 15 of your first semester at Messiah College.  If you have neglected to get a physical examination before arriving on campus you will need to find a physician off campus to complete this step before being permitted to practice or play.