Sickle Cell Trait Form for NCAA Intercollegiate Athletics

Sickle Cell Trait Information

Sickle Cell Trait is not a disease, and typically symptoms and/or health problems are not present.

Sickle Cell Trait is an inherited gene that affects hemoglobin, the substance associated with red blood cells ability to carry oxygen.

Sickle Cell Trait affects three million Americans and many may be unaware they have the gene. Sickle Cell Trait most commonly affects

African-Americans, but also includes those with descent from sub-Saharan Africa; Mediterranean countries such as Turkey, Greece, and Italy;

South and Central America; India and Saudi Arabia. Anyone from any ethnicity may test positive.

Sickle Cell Trait poses a serious threat as it does not typically present with any symptoms or general health problems. Issues may arise for

those affected during long durations of intense physical activity. These issues can be exacerbated by dehydration, high altitude, increased

atmospheric pressure, and/or extreme heat.

NCAA Requirement

The NCAA has mandated that all new incoming student-athletes for the Fall of 2013, and ALL student-athletes for the 2014-2015 academic

year be educated on their Sickle Cell Trait status.

Student-Athletes have the following options: 1) Show proof of Sickle Cell testing done at birth; 2) Consent to a blood test; or 3) Sign the

waiver below declining options 1 and 2, assuming all risk associated with participation. Whichever option is chosen, it must be completed

before the student-athlete is permitted to participate in any intercollegiate activity.

Any student-athlete who tests positive for Sickle Cell Trait WILL BE PERMITTED to participate in intercollegiate athletics.

1.) Copy of newborn sickle cell testing result attached. ___/___/___

2.) Copy of recent sickle cell screening test result attached. ___/___/___

3.) Signed Sickle Cell Trait Testing Waiver

Sickle Cell Trait Testing Waiver

I,_________________________________, understand and acknowledge that the NCAA recommends that all student-athletes have knowledge of their

sickle cell trait status. Additionally, I have read and fully understand the aforementioned facts about sickle cell trait and sickle cell trait testing.

Recognizing that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior

injuries, ailments, and/or disabilities experienced, I hereby affirm that I have fully disclosed in writing any prior medical history and/or knowledge or

sickle cell trait status to Rosemont College’s Health Center and Athletics Department.

I do not wish to undergo sickle cell trait testing and I voluntarily agree to release, discharge, indemnify and hold harmless Rosemont College, its

providers, officers, managers, trustees, employees, agents, insurers, and their successors and assigns from any and all liability, claims for injuries or

harm, any and all damages, and causes of action whatsoever whether based in negligence or otherwise, either in law or in equity, which have arisen or

may arise out of or relate in any way to my refusal to be tested.

I have read and signed this document with full knowledge of its significance. I further state that I am at least 18 years of age and competent to sign this

waiver.

____________________________________ ______________________________________ _____________

Student-Athlete’s Signature Student-Athlete’s Print Name Date

____________________________________ ______________________________________ _____________

Parent/Guardian’s Signature (if under 18) Parent/Guardian’s Print Name Date