Insurance Requirement Acknowledgement
To:WPI student-athletes and parents
From: Dana L. Harmon, Director of Athletics
Subject: Student Athlete Insurance
Please note per the NCAA, all student-athletes must provide evidence of insurance that includes coverage for athletically-related injuries. This is a pre-requisite for practice and competition. No student will be allowed to participate in any way until such evidence of current insurance coverage is on file with the WPI Department of Athletics.
The enclosed Insurance Requirement Acknowledgement Form, a completed Information andMedical History Form, a completed Pre-Participation Exam (physical) Form and a photocopy of both sides of your current insurance card must be on file before a student can participate.
Your insurance coverage should have a limit of at least $90,000 and cover athletically-related injuries (no exclusions). If you have questions regarding the terms of your coverage, you should contact your insurer immediately. If your insurance does not cover athletically related injuries, you must purchase WPI’s student insurance for your son or daughter to participate. Information can be found at then click on
If your insurance does cover athletically related injuries but has exclusions and/or is less than $90,000 in coverage, please be aware that you are responsible for any and all expenses up to $90,000 unless you purchase additional coverage on your own or through WPI’s student insurance.
WPI will assume no responsibility whatsoever for the payment of, or authorization to pay, medical or dental expenses resulting from injuries that occur while participating in intercollegiate athletics at WPI.
For your information, the NCAA’s Catastrophic Injury Insurance Program covers student-athletes who are catastrophically injured while participating in a covered intercollegiate athletic activity (subject to all policy terms and conditions). The policy has a $90,000 deductible. This coverage does not qualify as the basic coverage required for participation in athletics at WPI. It 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
If you have any questions regarding this requirement, please contact Mike DeSavage at 508-831-5733.
This page does not need to be returned. It is provided for your information. This form must be signed by a parent, guardian, legal representative or policy holder
Acceptance of Risk: WPI, in compliance with NCAA guidelines, reminds its student athletes of the inherent risk of injury during intercollegiate athletic participation. WPI and its athletic administrators, coaches, and sports medicine staff share the management of these risks by endeavoring to create a safe environment for competition. For their part, student athletes are strongly advised to adhere to their coaches’, athletic trainers’, and associated physicians’ health and safety instructions (e.g. WPI Concussion Management Plan), including the rules of their sport, while participating in contests, practices, training sessions, and related travel to effectively reduce the risks of injury.
INSURANCE REQUIREMENT ACKNOWLEDGEMENT
I, ______, as parent, guardian or legal representative, attest that (name, please print)
______has insurance coverage under a current, in force insurance
(student-athlete name)
policy or policies for injuries that occur while he/she is participating in intercollegiate athletics.
I am aware that this coverage should be at least $90,000 and that I am responsible for any and all expenses up to $90,000.
If there is a material change in coverage or expiration of coverage, I agree to notify WPI of this development and update the insurance information I have on file with the WPI Athletic Department.
I understand and agree that WPI will assume no responsibility whatsoever for the payment of, or authorization to pay, medical expenses resulting in injuries that occur while participating in intercollegiate athletics at WPI.
______
(parent, guardian or legal representative signature) (date)