Student-Athlete Insurance/Pre-Participation Physical
School Year 2014-15
Welcome to Washington State University Athletics! Athletic Training Services provides medical care to student-athletes for athletic-related injuries while they are competing for WSU. WSU Athletics has an excess medical insurance policy that covers student-athletes in the event of an athletic-related injury after primary and secondary (if applicable) insurance pays on the claim. Student-athletes will NOT be able to practice until the following information has been received and the student-athlete has been cleared by the WSU training staff and physicians.
Below is a list of forms to be completed and returned to Jonell Peterson with a copy of the front and back of your Health Insurance Card(s) (primary & secondary), Prescription Drug Card and Dental Card. See below for return options.
All WSU Student-Athletes:
(Parent(s)/guardian(s) must sign most of these forms for any student-athlete under 18)
- ► General Information
- ► Insurance Information
All students are encouraged to have insurance. WSU offers a student medical plan that you can purchase (WSU Student Medical Insurance). All International students with F1 and J1 visa status who are enrolled at WSU are automatically enrolled in the WSU "iSHIP" (International Student Health Insurance Plan)
- ► Assumption of Risk and Release of Liability
- ► Medical Treatment Authorization
- ► Disclaimer of Protected Health Information
- ► Disclaimer of Protected Health Information (NCAA & Pac-12)
- ► Statement of Nutritional Supplements/Performance-Enhancing Substances
- ► Understanding Concussions
- ► New/Transfer Student-Athlete Medical Examination
WSU Athletic Training will provide the actual physical when you arrive in Pullman
- ► Sickle Cell Testing
WSU Athletic Training must have this information as soon as possible. You will not be able to practice with your team until this information has been received and completed!
Return forms by any of the following
Fax 509-335-4729 Attn: Jonell Peterson
Mail forms to: Jonell Peterson, Coordinator of Internal Operations - ATS
Washington State University - Athletics
P.O. Box 641602
Pullman, WA 99164-1602
Scan/PDF Email: email@example.com
Questions: please email or call Jonell Peterson: firstname.lastname@example.org or 509-335-0310.