University of Delaware
Department of Health, Nutrition & Exercise Sciences
Athletic Training Education Program
Athletic Training Student
Clinical Assignment Contractual Agreement
I accept this clinical assignment at
semester 20
. I have discussed my role and responsibilities with my clinical instructor/supervisor :
for the
My responsibilities may include but are not limited to:
• provide taping & wrapping
• provide first-aid for injuries
• fill out injury report forms
• keep training room orderly & clean
• travel to “away” competitions (see back)
• keep coaches informed of injuries
• attend practices and games
• inform the supervising athletic trainer
and coaching staff in advance of absences
• provide and make available water
• keep medical kits stocked and maintained
• contact supervising athletic trainer when injuries occur
• assist athletes with rehabilitation
• keep accurate records of hours worked
• know your limits and do not exceed them
• act in the best interest of the athlete/patient at all times!
• act in a professional and ethical manner
• act as an “Apprentice Athletic Training Student” (see back)
I agree to complete the necessary clinical hours in this setting so as to obtain the best possible experience. In so doing, I
will fulfill my duties to the best of my ability.
This is to certify that I have read and understand the responsibilities entrusted to me regarding the confidentiality of
student-athlete medical records. I understand that by having access to medical records I become an integral part of this
confidential relationship between the student-athlete and the medical team. I must not divulge, under any circumstance,
medical (or other) information entrusted to me and my care.
I accept this contract with the understanding that I am representing the University of Delaware undergraduate Athletic
Training Education Program (ATEP) at all times. In accepting the terms of this contractual agreement, I understand that
being assigned to this clinical site is a commitment that is preparing me to be an entry-level certified athletic trainer. I
understand that I will be closely supervised and evaluated. Furthermore, I understand that my evaluation will become
part of my personal records and my performance will partially determine my continuance in the program.
Student’s Name:
Student’s Signature :
Date:
Clinical instructor’s Signature:
Date:
Program Director’s Signature:
Date:
Physical Examination Requirement
CPR and AED Certification
First Aid Certification
Hepatitis B Vaccination
TB Test Verification
Bloodborne Pathogens Training
HIPPA & FERPA Training
Reviewed the ATEP Communicable Disease Policy
Background Check (if applicable)
UD Athletic Training Room Confidentiality Form (if applicable)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No