


Returning Student Physical Form 2011-2012
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Parent/Guardian Athletic Student Information 2011-2012
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This form is required by all returning student-athletes. In addition this form must be completed by an M.D. or D.O. or it will not be accepted.
Please include a front and back copy of the student-athlete's insurance card.
This form provides the Athletic Training Department with primary insurance coverage information and must be filled out in its entirety.
Return all forms to the Athletic Training Department by August 1st.
Athletes will not be allowed to participate until all information is on file with the Athletic Training Department.
If at any time you have questions or concerns which we may help you with, please do not hesitate to contact us.
James Day MEd, ATC, LAT, CSCS
Head Athletic Trainer
Tel: 712.749.2257
Fax: 712.749.1460
Danelle Smith MA, ATC, LAT
Athletic Training Education Program Director
Tel: 712.749.2258
Fax: 712.749.1460