Student-Athlete Medical Eligibility Checklist
My name is Kelsey Bains and I will be your Certified
Athletic Trainer at Santiago
As your athletic trainer my job is to prevent, evaluate, diagnose, treat, and
rehabilitate athletic injuries. I am looking forward to your participation as a
Student-Athlete at Santiago Canyon College and wish you great success in your
academic and athletic pursuits. As a student-athlete you will have access to
SCC’s Team Physician and Certified Athletic Trainer, whom are available to you
in order to help care for any injuries or illness you may sustain while
participating in intercollegiate athletics at Santiago Canyon College.
In accordance with the California Community College
Athletic Association (CCCAA), I require that the following medical
documentation be complete and returned to Santiago Canyon College by Tuesday, August 5th:
Santiago Canyon College-Athletic Training
All the documents that you need to complete are located
on the Santiago Canyon College Athletics website under the Athletic Training
completion of these required documents will delay your ability to
participate in ANY team activities. Please
complete the following checklist and return all documents to the above address/location.
_____ Log in to your account at www.SWOL123.net (further instruction found
Canyon College New Student Athlete Packet:
You, as the student-athlete, are responsible to complete the paperwork
either by filling out on-line and printing, or by printing the requested
information and filling out in blue/black ink.
You must sign the appropriate pages where indicated and complete all
required documents. The New Student-Athlete Packet includes:
of Risk (pg. 1) pHIPPA Release (pg. 2) pApproval/Consent to Treat (pg. 3)
History Form (pg. 4-6) pInsurance Reporting (pg.
of the front and back of the Primary Insurance Card for the policy under
which, you, the student-athlete is covered. If you, the student-athlete are
covered by more than one policy, please include copies of cards for all
policies. Upload them to the appropriate section in SportsWare
_____ Complete a Pre-Participation Physical Examination (PPE) using the form located
in the New Student-Athlete Packet titled PPE evaluation Form (pg. 7).
A new physical is required each academic year. A Medical Physician (MD/DO) or a Physician
Assistant (PA-C) working under a physician must SIGN and provide an
office STAMP on the provided form
from his/her establishment.
_____ If you have had surgery or have been under the
care of a physician for an injury or illness within the past 12 months,
you must provide:
§ A note
clearing you for unrestricted participation in the intercollegiate sport you
are intending to play, or a note describing your current activity restrictions
notes, including post-op reports, imaging reports, and any precautions or
restrictions related to the treated condition
College aims to provide
student-athletes with the best possible medical care. If you have any questions
regarding any of these forms or policies, please do not hesitate to contact me
at (714) 628-4704 or email me at Bains_Kelsey@sccollege.edu.
Kelsey Bains, MS, ATC
Forms to be competed by Student-Athlete:
New Student-Athlete Packet
Injury and Concussion Acknowledgement
Medical Authorization for Minors (If Applicable)