Medical Eligibility Requirements for Incoming Students

MGSA Dance Pre-Participation Assessment

Incoming BFA students, in order to participate in collegiate dance classes, must complete the Pre-Participation Assessment. This includes the Preliminary form submission and Physical Exam. Students will NOT enter into any dance classes without completing the assessment. 

Preliminary form submission

There are a total of 3 forms that must be received by May 25, 2018:

1. The 2-page Email Consent Form.

2. The 2-page PPE History Form
            a. For any "Yes" answer in the PPE History form, please provide the following information on page 2:
                 i. When did this problem occur?
                 ii. What was the specific diagnosis?
                 iii. How was it treated?
                 iv. When was your last medical evaluation/treatmen for this issue?
                 v. Are you currently undergoing any physical therapy or other treatmetns for this issue?
                  vi. Has this issue still be active or affecting you recently/currently?
 

3.  If you are under the age of 18 at the time the student is filling out the form, parent/guardians must fill out Permission to Diagnose and Treat Minors Form.

Forms MUST be FAXED to:
Fax Number: 732-932-8255
Subject: MGSA 2018 Dance Pre-Participation Forms
Attention: Rose Bartley, Asst. Dir Health Information & Patient Service
EMAILED FORMS WILL NOT BE ACCEPTED
KEEP A COPY OF YOUR RECORDS IF YOU NEED TO RESUBMIT THE FAX
 
 

Physical Exam: Schedule an appointment with your physician

1. Print the Physical Exam Form and Clearance Form. Take them with you to your scheduled evaluation with your physician.

8. Please fax the completed Physical Exam Form and Clearance Form, no later than, Friday, June 22, 2018. 

Forms MUST be FAXED to: 
Fax Number: 732-932-8255 
Subject: MGSA 2018 Dance Pre-Participation Forms 
Attention: Rose Bartley, Asst. Dir Health Information & Patient Service
EMAILED FORMS WILL NOT BE ACCEPTED
KEEP A COPY OF YOUR RECORDS IF YOU NEED TO RESUBMIT THE FAX
 

**Please note: Keeping compliant with student privacy laws, only the Rutgers Student Health sports medicine physician and athletic trainer will have access to this assessment. Please do not e-mail any of these forms.**