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Grand Valley State University Athletics

Athletic Training Forms

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Dear Parent:

Welcome, on behalf of the GVSU Athletic Training Staff to another year of Laker Athletics. Please take a few minutes to review the following information, which includes some forms and medical paperwork that need to be downloaded, completed and returned to me. Also, here you can find the GVSU Medical Billing Payment Policies and Procedures, the GVSU Education and Support Program on Drug and Alcohol Abuse/Drug Testing Program, the NCAA List of Banned Substances and the HIPAA Statement for protected health information. Please take some time to read these documents, and feel free to contact me if you have questions. The following is a list of forms you will need to download and return when completed. These need to be sent in by 8/1/12, and failure to do so may result in a student athlete being held out of practice until the forms are complete.

*Medical Insurance Information Form
•If a part of the form does not apply to you (i.e. middle initial), please put a line through the space or write "N/A"
•Attach a front and back copy of your insurance card. If your insurance company does not issue cards, please write "N/A" in the space where the cards should be attached
•If you do not have medical or dental insurance, complete Section 1 (Student Athlete Information) on the form and report "No Coverage" under Section 4 (Medical Policy Information) Barbara Helms should be consulted for alternate insurance options.
•Please don't forget to sign the form
•Pay specific attention to: Medical and Dental Effective Dates, Insurance Limits, and Sport Exclusions
*Dental Insurance Information
*Secondary Insurance Information
*Medical History Form or Returner Medical History Form
*HIPAA Form
*Assumption of Risk/Consent to Treat Form
*Drug Testing Consent Form *Injury/Illness Reporting Agreement
*Sickle Cell Trait Awareness Letter (all incoming student athletes will be required to show proof of their sickle cell trait status)
*ADHD Reporting Form (all student athletes using ADD/ADHD medications will be required to complete this form)

Student athletes will not be allowed to participate until all of the above forms are completed.

Please read and understand the Medical Bill Payment Policies and Procedures, and if your child sustains an injury during the year that results in a bill, please refer back to the policy for pertinent information. Also, please read and understand the GVSU Concussion Management Policy, which has been formalized as a result of the NCAA Executive Council's stance on preventing significant concussions as a result of inappropriate management/reporting of concussions.

Also, each student athlete is required to have a pre-participation physical examination each year, with GVSU Team Physicians. That will be done when they arrive to campus, and specific dates will be as follows:

8-8-12: Football (6 pm)
8-12-12: Soccer and Volleyball (1 pm)
8-16-12: Cross Country, W Tennis, Track and Field* (6 pm)
8-25-12: Baseball (12:30 pm), Basketball (10 am), Golf (Noon), Swim/Dive (10:30 am), M Tennis (10:30 am), Track and Field** (10 am), Softball (Noon), Lacrosse (11 am)
*Denotes T&F athletes who live within 1.5 hours from campus
**Denotes T&F athletes who live more than 1.5 hours from campus

All pre-participation exams will be done in the Fieldhouse. Contact me if you have a conflict with times or dates. Anyone who does not show up for the exam at the times listed above and does not make other arrangements will be required to have a physical with our team physician at the student-athlete's expense.

Thank you for your time and attention to these details. Feel free to contact me at 616.331.3329 or at stoessnm@gvsu.edu if you have any questions.

Sincerely,
Mark A. Stoessner, MA, ATC
Head Athletic Trainer

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