Capital University

Returning Student-Athlete Medical Forms

Returning Student Athletes

On this page you will find a set of links to forms that need to be read, signed and returned by August 1, 2009. The forms deal with essential information the Athletic Department needs to better deal with the medical / injury care that incurs during ones season.

Please download, print, and complete the following forms: Please note that you must attach a copy of the front AND back of your insurance card in the space provided.

  1. Returning Athlete Physical Form (please complete address, emergency contact, and entire interim medical history information)
  2. Disclosure of Protected Health Information
  3. Permission to Treat and Consult
  4. Assumption of Risk
  5. Insurance Form (with copy of card attached)

Each returning student athlete will have this information on file prior to the beginning of their season. Please complete all forms and return by August 01, 2009. All insurance information and athletic physical exam must be on file in the athletic department before any student – athlete is eligible to participate.

Please mail the completed forms to the appropriate addresses shown below by AUGUST 1, 2009:

Capital University Athletic Training
Attention: Robert Thorne
1 College and Main
Columbus, Ohio 43209

Thank you for your assistance. If you have any question, please feel free to call me at (614) 236–6558 or email me at: rthorne@capital.edu 

Capital University
1 College and Main, Columbus, OH 43209-2394
614-236-6011
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