Pre-Participation Assessment

To participate in collegiate dance classes, all incoming BFA students must complete the Pre-Participation Assessment. This consists of the preliminary form submission and physical exam. After all required forms are submitted, Rutgers University’s Dr. Kenton will review for final medical clearance to participate in dance classes at Rutgers.

If you have opted to email your completed forms, please send them to Dr. Kenton at

If you have opted to fax your completed forms, please send them to:

Fax Number: 732-932-8255
Subject: MGSA 2021 Dance Pre-Participation Forms
Attention: Rose Bartley, Asst. Dir Health Information & Patient Services

Preliminary Form Submission - Due June 1

This form has three distinct sections that should be completed and sent to the Rutgers University Health Center.  Please be sure to fax or email all five pages of this document (contact information listed below).

  1. Preferred Mode of Communication Form: this form indicates your preferred mode of communication with health staff at Rutgers University Health Center
  2. History Form: this form should be completed with as much detail as possible. If further clarification is needed, you will receive an email from the Rutgers Student Health Sports Medicine Physician asking for further questions or informing you that further evaluation is needed by your home physician.
  3. For any “Yes” answer in the PPE History form, please provide the following information on page 3:
    1. When did this problem occur?
    2. What was the specific diagnosis?
    3. How was it treated?
    4. When was your last medical evaluation/treatment for this issue?
    5. Are you currently undergoing any physical therapy or other treatments for this issue?
    6. Has this issue still been active or affecting you recently/currently?
  4. Permission to Diagnose and Treat Minors Form: If the student is under the age of 18 at the time the form is being filled out, the student’s parent/guardians must fill out this page.
Physical Exam - Due July 15
  1. Schedule an appointment with your physician
  2. Print the Physical Exam Form and Clearance Form. Bring these with you to your scheduled evaluation with your physician.
  3. Fax or email the completed Physical Exam Form and Clearance Form no later than July 15, 2021.