Dear New Student-athlete and Parents/Guardians:
Enclosed is a packet of important forms that must be thoroughly completed and returned to the Hood College prior to any athletic participation. Please return the proper forms to the proper addresses by July 15th, 2012, for Health Center, and August 1st, 2012 for Sports Medicine Center. Please contact the Hood College Sports Medicine Center at (301) 696-3836 with any questions. If participating in a club sport (cheerleading and equestrian), we will need your Emergency Contact and Release form from Health Center, Medical Release Forms, and Code of Conduct Form.
NOTE: Student-athletes who have not completed and submitted these forms before the first day of practice will NOT BE ALLOWED TO PARTICIPATE.
The following forms need to be turned into Sports Medicine Center (Please check off before mailing!!)
http://www.hoodathletics.com/athletics-about/sports-medicine/pre-participation-forms
Supplemental Sports Pre-participation History Form (will be reviewed by our team doctor)
Medical Release Forms (need signed by an Insurance Policy Holder)
Please take ImPACT test (Concussion Baseline Test)
Code of Conduct Form
· Rules, guidelines, and procedures for Sports Medicine Center use and concussion information.
Waiver of Liability for Decline of Sickle Cell Solubility Test (If you decline the test for physical exam)
Attention Deficit Hyperactivity Disorder (ADHD) Medical Exemption Form (if it applies)
· Students MUST receive a proper documentation from a doctor for NCAA drug testing exemption.
Return all forms to: Hood College Sports Medicine Center, 401 Rosemont Ave. Frederick, MD 21701
Phone: 301-696-3836, Fax: 301-696-3673
The following Forms need to be turned into HEALTH CENTER
(In Orientation Package or http://www.hood.edu/Campus-Life/Health-Center/Forms.html )
Report of Medical History Form
· Required for all New Students. Located in the health forms sections of the Orientation Notebook
· Must be reviewed by healthcare professional at the medical examination.
Medical Exam Form
· Required for all New Students. Located in the health forms sections of the Orientation Notebook
· Must be performed and signed by an MD, DO, CRNP, or PA.
Emergency Contact and Release Form
· Required for all New Students. Located in the health forms sections of the Orientation Notebook
· Provide emergency contact and insurance information signed by an Insurance Policy Holder.
Immunization Form
· Required for all New Student. Located in the health forms sections of the Orientation Notebook
Return all forms to: Health Center: 401 Rosemont Ave. Frederick, MD 21701
Phone: 301-696-3439, Fax: 301-696-3442
**Please Note: If the student-athlete requires the use of some form of medication unique to him/her (i.e., asthma inhaler, epi-pen), please bring an extra with prescribing doctor’s note to be placed in the traveling med kit or to be used as a back-up in emergency situations. Also, if the student-athlete wears contact lenses, we suggest that he/she places a back-up set in the training med kit in case of loss or tear.
**Please Note: Although most of our student-athletes are not considered minors (under the age of 18), we strongly encourage all parents/guardians to read and sign to make sure they understand the guidelines and procedures of the Hood College Sports Medicine Center. If the student-athlete is considered a minor, the signature of a parent/legal guardian is required.
If we can be of any service to you as you prepare to travel to campus, please contact head athletic trainer, Akira Kondo,
at 301-696-3836, send a fax at 301-696-3673, or email to
Please keep a copy of all completed forms for your records.
Dear New Student-Athlete and Parent/Guardian:
Our sports medicine staff is looking forward to this coming intercollegiate sports season. Our goal in the department of athletics is to ensure the safety of our student-athletes. However, there is always the possibility of injury through participation in sports. The purpose of this letter is to inform student-athletes/parent/guardians of the insurance procedures that the college follows when a student-athlete sustains an injury.
All students must have health insurance in order to participate in the NCAA athletic program. We advise all student-athletes to have an insurance card for emergencies, in addition to the copy you provide to us. Student athletes may purchase an insurance plan through the Hood College. Information on the Hood College Student Accident and Sickness Insurance will be mailed out by the Accounting Office with the fall tuition bills. This policy DOES NOT cover any injury sustained while (a) participating in any intercollegiate, or professional sport, contest or competition; (b) traveling to or from such sport, contest or competition as a participant; or (c) while participating in any practice or conditioning program for such sport, contest or competition. Details on coverage can be found at http://www.hood.edu/Campus-Life/Health-Center/Student-Health-Insurance.html. Hood College is not responsible for any medical costs that a student-athlete incurs during participation. It is a student-athlete’s responsibility to inform us of any changes to his/her medical insurance or his/her health status as soon as possible.
Please note that the NCAA’s Catastrophic Injury Insurance Program covers student-athletes who are catastrophically injured while participating in a covered intercollegiate athletic activity. The policy has a $90,000 deductible and is supplemental coverage in the event of a catastrophic injury. More information on this program can be found on the NCAA’s web-site at www.ncaa.org. In the event that these requirements are not met, your son/daughter may be excluded from practicing and competing in varsity athletics.
The Hood College Sports Medicine Center works with a variety of health care practitioners to provide diagnostic, rehabilitative, and emergency care. Our staff will schedule appointments and will communicate directly with these providers. We always try to work with the student-athlete’s insurance. However, it may be necessary to use out of network providers to expedite treatment. If you have an insurance carrier that is an HMO, PPO, POS or PPN Manage Care provider you should be aware of the limitations of your coverage. Most have limited treatment areas or networks, which makes it difficult, if not impossible, to get elective medical services done while away at school. For instance, if your child injures his/her knee and appears to be an injury that may require a physician’s evaluation, x-ray or any other elective test, most manage care providers will require the athlete to return home to see the primary care physician; this can delay treatment and become very frustrating for the athletes and parents. In addition, there is the burden of traveling back and forth for appointments, which may cause the student to miss considerable class time. To help bridge this gap I have some suggestions, which will allow us some flexibility in treating your child if they do get injured:
1. Ask your insurance company about “Away From Home Program” for out of network services and out of state coverage. Example: Carefirst Away From Home Care
2. Change your child’s primary care provider to a local physician in Frederick, MD, through your insurance.
3. Contact your primary care physician and get pre-approval for any injuries incurred while at school
4. Consider another insurance carrier; some may be more expensive however coverage is more comprehensive
Our consulting and affiliated physicians are:
Dr. Jeffrey Gilsdorf (orthopedics) MMI, Orthopedic Associates of Frederick: 301-694-8311 www.mmidocs.com
Dr. Martha Pierce (internist) Hood College Wellness Center: 301-696-3439
Dr. David Grace (podiatrist) Foot & Ankle Care of Frederick: 301-698-9260
Dr. Deborah Morrone (chiropractor) Frederick Chiropractic Wellness: 301-695-0032 www.frederickchiro.com
If student-athletes/parents choose to see their own physician, they must provide our office with a doctor’s written note releasing them to play and give us specific instructions for their care. Keep in mind that an athletically related injury/illness is any condition that was caused by participation in sports or a condition that limits participation in practice or games. Please inform the sports medicine staff if student-athlete seeks treatment elsewhere.
Please note: This Insurance Coverage Agreement does not constitute a waiver of the Hood College Student Accident and Sickness Insurance Plan. The College requires that all full-time undergraduate students enroll in the Student Accident and Sickness Insurance Plan or submit evidence of comparable coverage by completing and submitting to the Accounting Office the Request for Waiver of Student Accident and Sickness Insurance. The Request for Waiver is a bright pink form included with the fall tuition bill.
The charge for the Hood College sponsored plan will be on the fall tuition bill. A credit of the insurance charge will be issued to the student’s account ONLY upon receipt by the Accounting Office of a completed and signed Request for Waiver form by the specified due date of the tuition bill. It is the student’s responsibility to verify that the Accounting Office has received the Request for Waiver form.