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All informational forms must be returned to the athletic training department
by Monday, July 1, 2013

Medical Forms for Student-Athletes

May 1, 2013

 Dear Xavier Gold Rush/Gold Nugget Student-Athlete and Parents,

 We would like to welcome you to the Athletic Department of Xavier University of Louisiana. We hope you are looking forward to an exciting and successful 2013-2014 athletic year. The athletic training staff is looking forward to working with you during your time with the Xavier Gold Rush/Gold Nugget family. It is the goal of our 		   
MAIL FORMS TO:

 Xavier University of Louisiana Athletic Department
Attention: Athletic Training Department
1 Drexel Drive, Campus Box 92
New Orleans, LA 70125
athletic training department to provide the highest quality of care possible should the need arise. In order to help us, we ask that you take the time to review and complete the accompanying informational forms. All the information must be completed and accurate before the student-athlete will be allowed to participate in any activities related to the 2013-2014 athletic season. Please take the time to accurately and fully complete the accompanying information and return the materials to the address listed below. Links to these materials can be found below. These forms are available in Microsoft Word formats.
Checklist of Information Materials that need to be returned:
Returning Athletes
#  Opening Letter
#  Insurance Explanation Letter, to be signed by student-athlete
#  Athlete Medical Profile Form
#  Parental/Guardian Insurance Information Form
#  Student Insurance Release Form (if you have no primary insurance)
#  2 Photo-copies of the Front and Back of your Medical Insurance Card
#  Athletic Training Room Rules and Procedures Form
#  Authorization and Consent to Treatment Form
#  Concussion Management Plan
#  Assumption of Risk Form
#  Physical Form 		     Athletes New to XU in 2013-14
#  Opening Letter
#  Insurance Explanation Letter, to be signed by student-athlete
#  Athlete Medical Profile Form
#  Parental/Guardian Insurance Information Form
#  Student Insurance Release Form (if you have no primary insurance)
#  2 Photo-copies of the Front and Back of your Medical Insurance Card
#  Athletic Training Room Rules and Procedures Form
#  Authorization and Consent to Treatment Form
#  Concussion Management Plan
#  Assumption of Risk Form
#  Physical Form

Thank you for your time.
Tiffany Gary

 		  Tiffany Gary ATC, LAT
Athletic Trainer
Office (504) 520-6702
tgary@ochsner.org
      Melvin Wallis

 		  Melvin Wallis ATC, LAT
Athletic Trainer
Office (504) 520-6702
mwallis@ochsner.org

 
 
Gulf Coast Athletic Conference

 National Association of Intercollegiate Athletics 		The Xavier Gold Rush and Gold Nuggets compete in Division I of the NAIA (National Association of Intercollegiate Athletics) as a member of the Gulf Coast Athletic Conference (GCAC). Xavier fields men's teams in basketball, cross country, tennis and track and field and women's teams in basketball, cross country, tennis, track and field and volleyball.

Department of Intercollegiate Athletics
Xavier University of Louisiana
1 Drexel Drive
Campus Box 92
New Orleans, LA 70125
(504) 520-7329 phone
(504) 520-7934 fax
 
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