Mount Ida College

Department of Sports Medicine

Sickle Cell Trait Wavier Documentation

Documentation for Diagnosis of Sickle Cell Trait

Sickle Cell trait is a genetic blood disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape. Sickling decreases the cells' flexibility and results in a risk of various complications during exercise, which may lead to death. The NCAA Legislative Council decided that ALL (REGARDLESS OF ETHNICITY) incoming student-athletes are advised tobe tested for sickle cell trait, show proof of a prior test or sign a waiver releasing an institution from liability if they decline to be tested. The legislation applies to student-athletes who are beginning their initial season of eligibility.

Getting results for Sickle Cell Trait can be done in the following ways:

  1. Have a blood test done by appointment or at the time of the yearly pre-participation physical with a physician.
  2. Most infants are screened for Sickle Cell Trait at time of birth, and documentation of past medical records can reveal if the patient has Sickle Cell Trait.

If the individual decides to waive testing for Sickle Cell Trait they MUST sit for an educational lecture on Sickle Cell to educate on signs, symptoms and dangers of participating with Sickle Cell Trait. At this time they can decide to continue to sign a waiver releasing the institution from liability if they decline to be tested.

Waiver of Sickle Cell Testing:

Although the institution has advised and explained the risks of sickle cell trait, I consent that I waive sickle cell trait testing releasing the institution from all liability of complications with sickle cell trait.

Signature: ______Date:______

Parent/Guardian signature: ______Date: ______(if under 18)

Mount Ida College

Department of Sports Medicine

Sickle Cell Trait Documentation

Patient Name: ______Date of Birth ____ /____ /____

Examination / Result
Sickle Cell Trait / □ Positive □ Negative

Additional Comments:

Applicant may participate in sports:

 Without restriction in NCAA sanctioned sports

 With the following restrictions in NCAA sanctioned sports______

 Should not participate in NCAA sanctioned sports

______

Name of Health Care Professional Date

______

Signature of Health Care Professional Office Phone Number

______

Office Address City State Postal Code

I consent to all information above, based on my medical records. I ______give permission to release all information to the Mount Ida College Athletic Training Staff and Health Services.

Signature: ______Date:______

Parent/Guardian signature: ______Date: ______(if under 18)