Athletic Trainer tending to student Athlete
Athletic Training


Student-Athlete Physical Forms and Insurance Information


The following information will need to be filled out completely and returned to the Athletic Training Department by July 25, 2009. If you are having difficulty obtaining the forms please feel free to e-mail or call Jon Mitchell, MA ATC at (704) 406-3912 or jmitchell@gardner-webb.edu.

You can download the forms by simply clicking the name of the form. All forms are in PDF format.

***Please Note:  We have made major changes to the insurance requirements for all new student-athletes for the 2009-2010 academic year.   Policies and forms have been updated to reflect these changes.  All new student-athletes will be required to have primary insurance coverage in the State of North Carolina that will cover intercollegiate athletics with a minimum of a $10,000 benefit.  

 
All First Year Participants in Athletics at Gardner-Webb University
Includes: Freshmen, and Transfers

Download all forms for First-Year Participant in one combined document

  1. Vice President for Athletics Insurance Letter (Freshmen and Transfers please open and review)
  2. Gardner-Webb University Insurance Requirements (Freshmen and Transfers only)
  3. Acknowledgement of Insurance Statement
  4. Parent Information Form
  5. Hospital Emergency Information
  6. Director of Athletic Training Letter (please open and review)
  7. Medical History
  8. Female Pregnancy Statement (female student-athletes only)
  9. Substance Abuse Education and Testing Policy (please open and review)
  10. Substance Abuse Education and Testing Policy - Appendix A
  11. Consent to Participate / Medical Consent
  12. Helmet Warning (Football Only)
  13. Concussion Screening Recovery Scale
  14. HIPPA
  15. Nutritional Supplements Disclosure
  16. Prescription Medication Disclosure


Note: All student-athletes are required to submit a photocopy (front & back) of their health insurance card.



Second, Third, Fourth, and Fifth Year Participants in Athletics at Gardner-Webb University
Includes: Sophomores, Juniors, Seniors, and Fifth-Year Seniors

Download all forms for Second,Third, Fourth and FifthYear Participant Forms in combined document

  1. Vice President for Athletics Insurance Letter (Sophmores, Juniors, Seniors and Fifth-Year Seniors please open and review)
  2. Acknowledgement of Insurance Statement
  3. Parent Information Form
  4. Hospital Emergency Information
  5. Director of Athletic Training Letter (please open and review)
  6. Medical History Update
  7. Substance Abuse Education and Testing Policy (please open and review)
  8. Substance Abuse Education and Testing Policy - Appendix A
  9. HIPPA
  10. Nutritional Supplements Disclosure
  11. Prescription Medication Disclosure

All forms must be completed in FULL. Please send completed forms and a copy of the front and back of your insurance card to the following address:

Jon T. Mitchell, MA ATC-L
Service Program Director
Gardner-Webb University
PO Box 877
Boiling Springs, NC 28017

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