Spring Hill College Athletic Training Department

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Britney McGee
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1 NCAA Division II Tryout Dear Parents/Guardian: Welcome potential new Badger and Family! Below is a list of what we need completed before your tryout: Copies of the front and back of your health insurance card Insurance Policy Holder s ID Student-Athlete s ID NCAA Sickle Cell Trait Form Prospective Student-Athlete Questionnaire (a medical exam may be required as part of your tryout) Pre-Participation Physical (completed by an MD or DO within the last 6 months) NCAA Division II Tryout Form/Release Agreement Please send (mail or ) all required information to the Athletic Training Department. If you have any questions please feel free to call or us (contact info below). We look forward to your visit to campus, Dani, Abigail, James Athletic Training Department Spring Hill College 4000 Dauphin Street Mobile, AL (O) (251) athletictrainer@shc.edu

2 Insurance Card Information Please copy the front and back of the student s current insurance card and affix it below. Front Back Please copy the POLICY h older s government -issued photo ID and affix it below. Policy holder s government-issued photo ID Please copy the ST UDENT S government -issued photo ID and affix it below. Student s government-issued photo ID 2 11/2017

3 Sickle Cell Trait Waiver Form I, understand the implications of playing sports with Sickle Cell Trait. I also understand it is in my best interest to be tested for sickle cell trait. If I have sickle cell trait, I will abide by the precautions set forth in this policy. I will work with the SHC Athletic Training Staff and my coach to develop the best plan for my continued safe participation in athletics at SHC. For more information go to: Student Signature: Date: MUST SIGN ONE OF THE FOLLOWING (NOT BOTH) AGREE OR REFUSE I agree to testing or to provide documentation in regards to sickle cell testing. Student Signature: Date: I refuse testing or to show documentation in regards to sickle cell testing. I also release SHC Athletics and athletic training from any litigious or financial repercussions should a sickle cell situation present itself. Student Signature: Date: Parent Signature (If student is under 19): Date: 3 11/2017

4 Prospective Student-Athlete Medical Disclosure Form (Please print and use pen) NAME SPORT TODAY'S DATE BIRTHDATE / / SCHOOL CURRENTLY ENROLLED HOME STREET ADDRESS HOME CITY, STATE_, ZIP CELL PHONE ( ) ADDRESS: Head / Concussion Yes No 1. Have you ever been diagnosed with a concussion? 2. If yes, how many? 3. Have you ever been hospitalized with a head injury? 4. Do you have any vision problems? 5. Do you wear glasses or contact lenses during competition? Upper Extremity Yes No 1. Have you ever had either shoulder "pop out" or "dislocate"? 2. Do you experience any grinding or popping pains in either shoulder? 3. Have you ever fractured or dislocated an elbow, forearm, wrist, hand or finger? 4. Have you ever experienced any pain throwing and/or weight lifting? Lower Extremity Yes No 1. Have you had a hip or pelvic fracture? 2. Do you experience frequent hip pain during athletic activity? 3. Have you experienced a "pulled" or strained hamstring, quad or groin? 4. Have you ever suffered a knee injury? (ligaments, cartilage, kneecap) 5. Have you ever had a knee injury which required crutch-walking or surgery? 6. Do you experience any on-going knee problems? (pain, swelling, stiffness, instability) 7. Have you ever had a foot or ankle injury that required a cast or surgery? 8. Do you experience any on-going foot or ankle problems? (pain, swelling, stiffness, instability) 9. Do you wear any type of orthotic, support or brace? 4 11/2017

5 Spine Yes No 1. Have you ever had a strain to the neck that caused a burning sensation in either arm? 2. Has a neck problem or injury ever caused a prolonged weakness of your arm or hand? 3. Have you ever sustained a neck fracture? 4. Have you ever experienced any neck pain? 5. Have you ever experienced any mid back pain? 6. Have you ever experienced any low back pain? 7. Have you ever sustained a fracture or disc problem in the low back? 8. Have you ever had a low back problem that caused a burning sensation in either leg? 9. Have you ever experienced any back pain while weight lifting or playing your sport? Heat Illness Yes No 1. Have you ever had any trouble with dehydration? 2. Have you ever passed out in the heat? 3. Have you ever had Heat Cramps (from fluid loss because of excessive heat)? General Medical Yes No 1. Have you ever had an injury to or a problem with the spleen, liver, kidneys or reproductive system? 2. Do you have a heart murmur or other irregularity? 3. Do you experience shortness of breath, heart palpitations, dizziness or fainting, weakness or paralysis? 4. Have you ever been under treatment for hypertension, diabetes, cancer, epilepsy, asthma or any other medical condition? 5. Do you have the absence of a paired organ? (eye, ear, kidney, etc) 6. Have you received treatment or counseling for a nervous condition, personality or character disorder, emotional or substance abuse problem? 7. Females Only - Have you been under treatment for any recent or on-going gynecological problems? 8. Have you experienced any recent weight loss or gain? 9. Have you ever been diagnosed with a stress fracture? 10. Do you adhere to any specific diet regimen? 11. Do you take any vitamins, supplements, or other nutritional aids? Conditioning Status (What have you done to stay in shape?) Please explain in this section: 5 11/2017

6 General Information 1. Indicate any injuries that have required surgery, and the surgery date: 2. Have you been told you should have surgery and chose not to undergo surgery? Yes No If yes, when and why? Date Date Date 3. Indicate any injury or other problem that will require surgery prior to athletic participation at Spring Hill College. 4. Have you ever been told by a physician that you should not participate in athletics? Yes No If yes, when and why? 5. May the Spring Hill College medical staff contact this physician? Yes No Physician's Name Address Phone Number City/State/Zip 6. List all prescription medication used in the past 12 months: Do you currently wear any supportive/protective device (brace, sleeve, support) or require taping for athletic participation? Yes No If so, please elaborate Any significant injury requiring physician's care over the past three years will require medical reports and/or physician clearance for athletic activity on file in the Athletic Training Office. By my signature, I agree that all of the preceding information is answered accurately and to the best of my knowledge. I understand that if I have fraudulently misrepresented any information regarding my medical history, institutional financial aid based on athletic ability may be reduced or canceled. Student Signature: Parent/Legal Guardian Signature (If student is under 19) Date: Date:

7 Spring Hill College Sports Medicine Pre-Participation Physical Examination Must Be Completed by a Licensed Physician (MD or DO) Name Date of Birth Sport(s) Height Weight Pulse BP / Vision R 20/ L 20/ Contacts Yes or No NORMAL ABNORMAL FINDINGS Appearance Eyes/Ears/Nose/Throat Lymph Nodes Heart Pulses Lungs Abdomen Genitalia (males only) Skin MUSCULOSKELETAL Neck Back Shoulder/Arm Elbow/forearm Wrist/hand Hip/thigh Knee Leg/Ankle Foot Cleared For Athletic Participation Cleared After Completing Evaluation/Rehabilitation For: Limited Participation: Reasons: Not Cleared Recommendations: All physician contact information must be completed in full and legible otherwise physical is invalid Name of Physician (print/type/stamp): Date Address: Phone Signature of Physician (M.D. or D.O.) 7 11/2017

NCAA DIVISION II TRYOUT FORM PROSPECTIVE STUDENT-ATHLETE Student Name: Date of Birth: Eligibility Center ID#: UPROSPECT INFORMATION Sport: Grad Date: Date of Tryout: TRYOUT INFORMATION Per Bylaw 13.

8 NCAA DIVISION II TRYOUT FORM PROSPECTIVE STUDENT-ATHLETE Student Name: Date of Birth: Eligibility Center ID#: UPROSPECT INFORMATION Sport: Grad Date: Date of Tryout: TRYOUT INFORMATION Per Bylaw , a member institution may conduct a tryout of a prospect only on its campus or at a site at which it normally conducts practice or competition beginning June 15 immediately preceding the prospective student-athlete s junior year in high school and only under the following conditions: (a) No more than one tryout per prospective student-athlete per institution per sport shall be permitted; (b) The tryout may be conducted only for high school prospective student-athlete who are enrolled in a term other than the term in which the prospective student-athlete s high school's traditional season in the sport occurs or who have completed high school eligibility in the sport; for a two-year college student, after the conclusion of the sport season or anytime, provided the student has exhausted his or her two-year college eligibility in the sport; and for a four-year college student, after the conclusion of the sport season, provided written permission to contact the prospective student-athlete (per Bylaw ) has been obtained; (c) The tryout may include tests to evaluate the prospective student-athlete s strength, speed, agility and sport skills. Except in the sports of football, ice hockey, lacrosse, the tryout may include competition. (d) Competition against the member institution's team is permissible, provided such competition occurs during the academic year and is considered a countable athletically related activity per Bylaw ; (e) The time of the tryout activities (other than the physical examination) shall be limited to the length of the institution's normal practice period in the sport but in no event shall it be longer than two hours; and (f) The institution may provide equipment and clothing on an issuance-and-retrieval basis to a prospective student-athlete during the period of the tryout. Compliance Office and Athletic Trainers will approve tryout period and participants prior to the date of the tryout. RELEASE AGREEMENT My son/daughter, as noted above is in excellent physical condition according to our family physician. I hereby release and forever discharge any and all rights and claims for damages against Spring Hill College and any and all of its employees. I further authorize Spring Hill College to act for me according to their best judgment in an emergency requiring medical attention on my son/daughter. I understand that my insurance policy will be used to cover the cost of any accidents or injuries and that Spring Hill College is not covering this tryout under its insurance policies. I understand all the regulations regarding a NCAA Division II tryout and I meet those conditions. I further understand the release statement as written above and agree to the terms. Student: Parent or Guardian: Date: Date: Date Approved by Compliance: 8 11/2017

Team Knightro Tryout Checklist

Team Knightro Tryout Checklist What to Bring the First Day of Tryouts 1. Bring a "copy" of either your UCF Student I.D. or "copy" of your acceptance letter. * Please do not bring the originals as a copy