Medical Forms for YC Student Athletes

NOTE: You must print, complete and submit the appropriate forms. All applicable forms need to be filled out completely, accurately, and returned to the Sports Medicine staff the week before the first day of practice/conditioning, your eligibility depends upon it.

Athletic Medical History

Athletic Medical History - This is to gather important information regarding your past medical history, please be thorough and accurate. It is helpful to complete this with the physician performing for physical exam. This form will need to be printed and completed by hand.

Physical Exam

Physical Exam (attached to the Medical Exam form - see above) - This form will be filled out by your physician at the completion of your sports physical exam. We require athletes at Yavapai College to use this form to ensure a standardized exam. This is the second page of the Medical History form, please scroll down. As with the Athletic Medical History you will need to print this out and complete it by hand.

Verification of Other Insurance

Verification of Other Insurance - The insurance that Yavapai College provides for athletics is strictly a secondary provider. They will not process any claims until they have verification of other insurance. If you are not covered by insurance we recommend that you look into getting some before your participation. To learn more about the insurance Yavapai College has for its athletes

Emergency Information

Emergency Information - In case we need to contact your family/friends, this is where we get the information.

Consent to Participate

Consent to Participate - Participation in sport is hazardous. You are acknowledging that athletic participation can harm you and you are voluntarily participating and accepting these risks. If you are under 18 years of age, your parent/guardian needs to cosign. (This form is part of the Emergency Information form, please scroll down to complete it)

Use of Medications

Use of medications - Use of over the counter medications, while not prohibited, does have risks associated with their use. However, these risks are deemed to be small. This form acknowledges that you are aware of these risks and accept responsibility for their use.

Athletic Medical Record Release

Your medical records and information is protected. Complete this form if you want to give your permission for us to share this information with others that may or may not be involved in providing treatment to you. Once this information is shared with others they may not be under obligation for confidentiality. You may rescind this approval at anytime in writing.

Previous Injury Release Form

Previous Injury Release Form - In the event that you had a medical condition that prevented your participation in any athletic related activity within the last twelve months, you will need to be released by the physician who provided the care. You will want to print this form out and have it completed before getting to campus.

Explanation and Acknowledgement of Yavapai College Athletic Medical Services

Explanation and Acknowledgement of Yavapai College Athletic Medical Services - This document explains the basics of athletic medical care should an injury occur. It also outlines Yavapai College's athletic insurance policy. You should read the material and then sign the bottom of the form.

(back to top)