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8045 E. Chapman Ave. Orange, CA 92869 (714) 628-4900
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Returning Student-Athlete Information

Returning Student-Athlete Medical Eligibility Checklist


SCC Student-Athlete,


I am looking forward to your continued participation as a Student-Athlete at Santiago Canyon College and wish you great success in your academic and athletic pursuits. As a student-athlete you will have access to SCC’s Team Physician and Certified Athletic Trainer, whom are available to you in order to help care for any injuries or illness you may sustain while participating in intercollegiate athletics at Santiago Canyon College.


In accordance with the California Community College Athletic Association (CCCAA), I require that the following medical documentation be complete and returned to Santiago Canyon College by Thursday, August 1st:


Santiago Canyon College-Athletic Training

Attention: Kelsey Bains, ATC

8045 East Chapman Ave, S-104

Orange CA, 92867


All the documents that you need to complete are located on the Santiago Canyon College Athletics website under the Athletic Training Tab. Late completion of these required documents will delay your ability to participate in ANY team activities. Please complete the following checklist and return all documents to the above address/location.


_____ Santiago Canyon College Returning Student Athlete Packet:  You, as the student-athlete, are

             responsible to complete the paperwork either by filling out on-line and printing, or by printing

             the requested information and filling out in blue/black ink.  You must sign the appropriate

             pages where indicated and complete all required documents. The Returning Student-Athlete

            Packet includes:


pAssumption of Risk (pg. 1)        pHIPPA Release (pg. 2)               pApproval/Consent to Treat (pg. 3)

pHealth History Form (pg. 4-5)    pPPE Evaluation Form (pg. 6)      pInsurance Reporting (pg. 7-10)


_____  Complete a Pre-Participation Physical Examination (PPE) using the form located in the

              Returning Student-Athlete Packet titled PPE evaluation Form (pg. 6). A new physical is

              required each academic year. A Medical Physician (MD/DO) or a Physician Assistant (PA-C)

              working under a physician must SIGN and provide an office STAMP on the provided form from

              his/her establishment.  


_____  A Photocopy of the front and back of the Primary Insurance Card for the policy under which,

              you, the student-athlete is covered. If you, the student-athlete are covered by more than one

              policy, please include copies of cards for all policies.

_____ Complete the Injury and Concussion Acknowledgement


   _____  Log in to your account at (please make sure all information is current)


_____  If you have had surgery or have been under the care of a physician for an injury or illness

             within the past 12 months, you must provide:

          • A note clearing you for unrestricted participation in the intercollegiate sport you are intending to play, or a note describing your current activity restrictions
          • ​Physician notes, including post-op reports, imaging reports, and any precautions or restrictions related to the treated condition


 Santiago Canyon College aims to provided student-athletes with the best possible medical care. If you have any questions regarding any of these forms or policies, please do not hesitate to contact me at (714) 628-4704 or email me at




Kelsey Bains, ATC


Forms to be completed by Student-Athlete:

Returning Student-Athlete Forms

Injury and Concussion Acknowledgement