Developmental Baseball Students

Welcome, Developmental Baseball players!

Your understanding of the policies and procedures related to health care, privacy, and health insurance 
is critical to your success as a student-athlete. Please carefully read all of the information that follows 
before completing and submitting the forms.

All forms must be completed in their entirety, and all requested documentation must be submitted 
before you will be permitted to participate in any sport-related activity at Daytona State. Please type
your responses directly on the forms, and then choose one of the following options:

1. Email to burnst@DaytonaState.edu or

2. Print and mail to:

Trevor Burns
Daytona State College
Athletic Department Bldg. 310
1200 W. International Speedway Blvd.
Daytona Beach, FL  32114

Deadline to return all forms is September 1, 2013
Faxed forms will NOT be accepted
(Scanned & e-mailed forms will be accepted)

The following items are for you to read and keep for reference:

Procedures Regarding Athletic Injuries, Illness & Medical Care

Notice of Privacy Practices

Sickle Cell Trait Information

Primary Health Insurance Resources

Please type your responses directly on the forms, sign and return to the above address:

Medical History Questionnaire

Physical Form for Physicians

Asthma, Allergies & Chronic Conditions Form

Student-Athlete Insurance Information

Health Insurance Information Signature Page

Protected Health Information Consent

Sickle Cell Trait Testing Waiver