Medical Eligibility Requirements for Incoming Students

MGSA Dance Pre-Participation Forms Instructions

Please note: only the Rutgers Health Services sports medical sports medicine physician and the athletic trainer will have access to the medical histroy summary.

1. After officially enrolling you will have access to the enrollment pathway. There you can activate your Rutgers netid, which will be used to log into all current student platforms. After officially enrolling, you can activate your Rutgers NetID here: https://netid.rutgers.edu/activateNetId.htm

2. Fill out the 2-page Email Consent Form.

3. Complete the PPE History Form AND the Additional Information Form.

a. For any "Yes" answer in the PPE History form, please provide the following information on the Additional Information Form:

  • When did the problem occur?
  • What was the specific diagnosis?
  • How was it treated?
  • When was your last medical evaluation/treatment for this issue?
  • Are you currently undergoing any physical therapy or other treatments for this issue?
  • Has the issue still been active affecting you recently/currently?
  • b. If you are under the age of 18, these forms are to be filled out by the student and parent/guardian, in addition to the Permission to Diagnose and Treat Minors Form.

    4. Please fax completed Email Consent Form, PPE History Form, Additional Information Form, and Permission to Diagnose and Treat Minors Form (if applicable), no later than, Monday, May 15, 2017.

     

    Forms MUST be FAXED to:
    732-932-8255
    Subject: MGSA 2017 Dance Pre-Participation Forms
    Attention: Rose Bartley, Asst. Dir Health Information & Patient Service

    5. Schedule an appointment with your physician.

    6. You MUST bring the PPE Physical Exam Form and the Clearance Form with you to your scheduled evaluation with your physician.

    7. Please keep a copy of all completed forms for your records.

    8. Please fax completed PPE Physical Exam Form and Clearance Form, no later than, Friday, June 2, 2017. 

    Forms MUST be FAXED to: 
    732-932-8255 
    Subject: MGSA 2017 Dance Pre-Participation Forms 
    Attention: Rose Bartley, Asst. Dir Health Information & Patient Service

     

    **Please fax all forms to the number listed above. Forms will not be received through email.