Download New-Athlete Medical Checklist

Dear Incoming Student-Athlete:
Congratulations on your decision to become a Knight! I’m very excited about the coming year
and having you join our campus community!
Sports Medicine
Spoelhof Fieldhouse
Complex
Playing college sports is going to be a lot of fun, but it also involves a lot of responsibility. This
document is intended to help you better understand some of your initial responsibilities. It
contains important information and instructions you’ll need to follow in order to become
medically eligible to participate in an official team activity. Please read this letter and instructions
carefully to make sure that you understand everything you must do before coming to campus. I
realize this is a lot of information and it does take time, but doing these things ahead of time
makes things much easier once you get to school. Also, it might be helpful to print a copy of this
letter and bring it with you to campus for reference as you prepare for your upcoming season.
3195 Knight Way SE
If you should have any questions or concerns about physicals or paperwork, please don’t hesitate
to contact us by phone at 616-526-7630 or email at [email protected].
Grand Rapids, MI
49546
See you soon!
Joe Dykstra – Head Athletic Trainer
Phone: 616-526-7630
New-Athlete Medical Checklist
Fax: 616-526-8478
www.calvin.edu
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*must be completed before moving to campus
*Read this letter and the following instructions
*Register online for your Pre-Participation Exam
*Create and complete your SportsWare Online account
*Complete, print, and sign all forms in the Incoming Athlete PPE Package,
saving a completed copy for backup
o Get parent/guardian signatures on all forms if under 18
*Submit general college forms and upload vaccination records to complete
Calvin College health requirements at calvin.medicatconnect.com.
Turn in completed forms (printed copy) ahead of time or bring them when
you report for your Pre-Participation Exam
Report for your Pre-Participation Exam at your scheduled time
o Write your scheduled date/time here: _______________________
Complete baseline concussion testing at your assigned time (if necessary)
o Write your assigned date/time here: _______________________
Attend the All-Athlete Meeting at 7:00pm on Thursday, September 7 in the
Chapel
Instructions
Pre-Participation Exam
New student-athletes (freshmen or transfers) who want to participate in NCAA Athletics or ACHA Men’s Ice Hockey
must have a Pre-Participation Exam (PPE) prior to participation in tryouts, practices, or games. This PPE must be done by
the Calvin College Team Physician and be completed through Calvin College Sports Medicine. A one-time, $15 charge
will be issued to your miscellaneous account after the completion of your PPE. You MUST register for your PPE ahead
of time. Please see the next section for instructions on registration.
Registering for your PPE
Pre-register for your PPE by choosing ONE of the dates below and following the registration link which will take you to a
separate website where you can register. Each date has a specific sport emphasis based on when your team starts official
activities, but you may register for any date based on your personal availability, regardless of sport. Note that the earliest
time slots must be filled before the later time slots will be opened. Exceptions to this can only be made in the case of longdistance travel or extenuating circumstances. If you have any questions or problems please contact us.
Friday, August 18, 2017 – 3:00pm
Emphasis on Men’s & Women’s Soccer, Volleyball, and Women’s Golf
August 18 PPE Registration Website
Tuesday, August 22, 2017 – 7:30am
Emphasis on Men’s & Women’s Cross Country
August 22 PPE Registration Website
Monday, August 28, 2017 – 5:30pm
Emphasis on Men’s Golf
August 28 PPE Registration Website
Thursday, August 31, 2016 – 12:00pm
Emphasis on Men’s Soccer, ACHA Ice Hockey, Men’s & Women’s Tennis, Baseball, Softball, and Men’s &
Women’s Track & Field, Men’s & Women’s Swimming & Diving, and Men’s & Women’s Lacrosse
August 31 PPE Registration Website
Monday, September 11, 2016 – 4:30pm
Emphasis on Men’s & Women’s Basketball
September 11 PPE Registration Website
All links for PPE registration will also be posted at: http://www.calvinknights.com/athletics/sports_med/physicals
Baseline Concussion Testing
Only athletes participating for the first time in the sports of Baseball, Basketball, Diving, Ice Hockey, Lacrosse, Pole
Vault, Soccer, and Softball must complete a computerized baseline concussion test, in addition to the physical exam. If
you plan to play one of these sports, you have a specific time and location for your test, based on your scheduled PPE
date/time:
*****Note that it takes about 35 minutes to complete the test, so please plan your schedule accordingly*****
If your PPE is scheduled for Friday, August 18:
 Then report for testing on Friday, August 18 between 5:00 and 5:45pm – North Hall, Room 180 (Near
Business Department)
If your PPE is scheduled for Tuesday, August 22:
 Then report for testing on Thursday, August 31 @ 2:30pm – Hekman Library, Room 120 (Near Calvin
IT)
If your PPE is scheduled for Monday, August 28:
 Then report for testing on Thursday, August 31 @ 2:30pm – Hekman Library, Room 120 (Near Calvin
IT)
If your PPE is scheduled for Thursday, August 31 between 12:00 and 3:00pm:
 Then report for drop-in testing on Thursday, August 31 between 3:00 and 5:00pm – Hekman Library,
Room 120 (Near Calvin IT)
If your PPE is scheduled for Thursday, August 31 between 3:00 and 5:00pm:
 Then report for drop-in testing on Thursday, August 31 between 1:00 and 3:00pm – Hekman Library,
Room 120 (Near Calvin IT)
If your PPE is scheduled for Monday, September 11:
 Then report for testing on Monday, September 11 between 5:30 and 6:45pm – Hekman Library, Room
120 (Near Calvin IT)
SportsWare Online
Calvin College Sports Medicine uses an online medical record keeping system called SportsWare Online. The program
allows you to update your information at any time, so if you move or your insurance changes, please keep your
information up to date. Please follow these steps to create your account:
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Go to: https://www.swol123.net
Scroll to the middle of the screen and click the Join SportsWare button.
Enter Calvin College as the School ID and click the Next button.
Enter your First Name, Last Name, Calvin College Email Address, and select the appropriate Group for you and
click the Send button.
5. Your request to join SportsWare will then be sent to Calvin College Sports Medicine for review.
a. Monitor your Calvin College email regularly for an email from [email protected].
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b. Open the email and click the link to create a password and finish creating your SportsWare account.
Once you have created a password, go back to https://www.swol123.net, enter your username (Calvin College
email) and newly created password and click the Login button.
Click on the My Info tab in the upper left hand corner and complete/update all fields for all tabs.
a. General: Fill out all pertinent fields under General and Sports/Group.
b. Address: Fill out all pertinent fields for Primary Address (Home) and Secondary Address (College).
c. Emergency: Fill out all pertinent fields for Primary Emergency Contact (Typically your parents) and
Secondary Emergency Contact (Typically a relative or close family friend).
d. Insurance: Fill out all pertinent fields for Primary Insurance Company. You only need to fill out
Secondary Insurance Company if you have insurance coverage under another policy (Not common).
e. Medical:
i. Alerts: Make note of any ongoing medical issues here by typing in the condition or selecting
from the dropdown (i.e. Asthma, Diabetes, Allergies, Epilepsy, etc.).
ii. Immunizations: Enter the date of your most recent vaccination for each condition listed.
iii. Drugs Taken: List ALL medications you take regularly by typing in the drug name and dosage
(i.e. Adderall, 20mg or Advair Diskus, 100/50)
iv. Doctor: Enter your personal physician’s name and phone number.
f. Paperwork: You do NOT need to complete this or any tabs after it.
g. Click the Save button to save all changes.
On your “Dashboard” (The main SportsWare page) it may say that “Your Medical History is INCOMPLETE.”
Please disregard this as we use a different method to collect your medical history.
Once all information is complete, click the Logout button in the upper right corner to ensure that no one else can
access your information.
Instructions for Completing the Incoming Athlete PPE Package
All required forms are located in one editable PDF document called the Incoming Athlete PPE Package. You will need to
have the Adobe Reader software, which you can download at: http://www.adobe.com/. You may choose to print it and fill
it out by hand or you can fill it out using your computer and then print it (Recommended). If you complete it using your
computer, make sure to save a copy of the completed document.
Either way you complete the forms, make sure to submit all completed forms by bringing copies with you to your PPE,
dropping them off ahead of time during our normal business hours once you get to school, or mailing them to us at:
Calvin College Sports Medicine
Attn: Sports Physicals
3195 Knight Way SE
Grand Rapids, MI 49546
Individual Form Instructions
1. Incoming Student-Athlete Pre-Participation Exam Form
a. Fill out all fields under “Personal Information” by typing in the information or using the drop-down tabs.
All fields surrounded by a red box are required.
2. Medical History Questionnaire
a. Answer all questions by selecting “Yes” or “No.” If you answer yes or check any boxes for specific
conditions, explain in the space provided.
b. Sign the document where indicated by choosing one of the following options:
i. Physically sign it after you have completed, saved, and printed the entire Physical Package.
1. If you are still a minor, please make sure your parent/guardian also signs/dates the form.
ii. Sign it electronically using Adobe Reader by clicking on the Sign, Add Text or Send a
Document for Signature button in the toolbar.
1. Click the Place Signature button to add or create a signature
2. Select Draw My Signature from the dropdown menu
3. Draw your signature and click the Accept button
4. Place the signature image wherever indicated in the document
5. Click the Add Text button to add the date where indicated in the document
6. If you are still a minor, please make sure your parent/guardian also signs/dates the form.
3. Incoming Student-Athlete Baseline Concussion Testing Form
a. Complete Part I only. For each symptom listed, select the number that is closest to how you normally feel.
b. Read and sign where indicated by choosing one of the previously explained signature options.
4. Student-Athlete Sickle Cell Trait Status Verification Form & Student-Athlete Sickle Cell Trait Status
Waiver
a. Completion of either one of these forms is required by the NCAA. Completion of the Verification Form is
recommended as it is preferred that student-athletes know their status to help ensure their health and wellbeing during athletic participation. Completion of the Waiver Form is not recommended.
b. If completing the Verification Form:
i. Many states require that infants are tested at birth. You can contact your pediatrician or place of
birth to have them fill out the “To Be Completed By Physician” section.
c. If completing the Waiver Form:
i. Read and sign the document where indicated by choosing one previously explained signature
options.
ii. Make sure that a witness also documents your signature.
5. Acknowledgement of Insurance Requirements and Coverage Form
a. Read and sign the document with your parent/guardian where indicated by choosing one of the previously
explained options and then attach front/back copies of your insurance card after printing.
i. If you are on your own health insurance plan (i.e. KnightCare) and not a minor, your
parent/guardian does not need to sign.
6. Incoming Athlete Waivers
a. Read and sign the document where indicated by choosing one previously explained signature options.
7. MIAA Individual Certification of Eligibility
a. Fill out all incomplete fields.
b. Read and sign the document where indicated by choosing one previously explained signature options.
8. Calvin College Sports Questionnaire
a. Fill out all incomplete fields.