New Student-Athlete Medical Eligibility Checklist
My name is Kelsey Bains and I will be your Certified Athletic Trainer at Santiago Canyon College. 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 Thursday, August 1st:
Santiago Canyon College-Athletic Training
Attention: Kelsey Bains, ATC
8045 East Chapman Ave, S-104
Orange CA, 92867
All the documents that you need to complete are located on the Santiago Canyon College Athletics website under the Athletic Training Tab. Late 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.
_____ Santiago 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
pAssumption of Risk (pg. 1) pHIPPA Release (pg. 2) pApproval/Consent to Treat (pg. 3)
pHealth History Form (pg. 4-6) pPPE Evaluation Form (pg. 7) pInsurance Reporting (pg. 8-11)
_____ 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
_____ A Photocopy 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.
_____Complete the Injury and Concussion Acknowledgement
_____ Log in to your account at www.SWOL123.net (further instruction found on website)
_____ 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
- Physician notes, including post-op reports, imaging reports, and any precautions or restrictions related to the treated condition
Santiago Canyon College aims to provided 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, ATC
Forms to be competed by Student-Athlete:
New Student-Athlete Forms
Injury and Concussion Acknowledgement
Medical Authorization for Minors