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Athletic Medical & Insurance Forms

In order to participate in Intercollegiate Athletics at Gwynedd-Mercy College, you must submit a completed physical and proof of valid medical insurance.

Physicals must be administered and signed by a licensed physician or certified registered nurse practitioner. These forms are good for one (1) calendar year from the date of signature by the physician. You must complete page 1 and page 4, while the physician completes page 2 and page 3.

Insurance verification & acknowledgment forms, along with a copy of your medical insurance card, must also be submitted. NCAA rules state all student-athletes must meet the following criteria regarding medical insurance:

1. Maximum Lifetime Benefit of at least $75,000
2. Coverage of injuries resulting from athletic participation

All forms must be completed, signed, and returned to the Head Athletic Trainer PRIOR to your 1st day of practice. If you have any questions, please contact the Head Athletic Trainer at 215-646-7300 ext. 251 or edinger.p@gmc.edu

Please return completed forms to:
Head Athletic Trainer
Gwynedd-Mercy College
1325 Sumneytown Pike
Gwynedd Valley, Pa. 19437

Download the Forms Here (PDF Format)

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