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 to be
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
Sickle Cell Trait
Result
□ 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)