Simmons College Athletics Department
Sickle Cell Trait Testing Information and Waiver Form
About Sickle Cell Trait:
 Sickle cell trait means that someone is a carrier for one copy of the abnormal gene that causes sickle cell disease.
Hemoglobin is the substance in red blood cells that helps carry oxygen. Red blood cells in individuals with sickle
cell trait contain some abnormal sickle hemoglobin, but most of the hemoglobin in each red blood cell is normal.
 Nearly 3 million individuals in the U.S. have sickle cell trait. Although it is most predominant in people of
African, Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, persons of
all races and ancestries may test positive.
 Sickle cell trait is generally benign and consistent with a long and healthy life. It is not a barrier to participation
in athletics, but under circumstances of intense exercise, heat exposure, and dehydration, athletes with sickle cell
trait may, very rarely, be at risk for exercise-related sudden death.
Sickle Cell Trait Testing:
 The NCAA requires all NCAA Division III student-athletes have knowledge of their sickle cell trait status or
sign a waiver declining testing and releasing Simmons College from liability before participating in any
intercollegiate athletics events, including strength and conditioning sessions, practices, competitions, etc.
 Of these options, the NCAA and Simmons College strongly recommend those student-athletes who are unable
to demonstrate their sickle cell trait status to undergo sickle cell trait testing prior to athletic participation.
 A copy of any test results should be forwarded directly to the Simmons College Health Center: 94 Pilgrim Rd.,
Boston, MA, 02215 or faxed to 617-521-3467. The Health Center can also arrange for you to have the test.
 Please feel free to call the Health Center with any questions: 617-52-1020
SICKLE CELL TRAIT TESTING WAIVER:
I, _________________________________________________________ , understand and acknowledge that the
NCAA and Simmons College recommend 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, reviewed the
Simmons College FAQ on sickle cell trait, and have viewed the NCAA video on sickle cell trait.
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 of sickle cell trait status to the Simmons
College Health Center.
I do not wish to undergo sickle cell trait testing as part of my pre-participation physical examination and I
voluntarily agree to release, discharge, indemnify and hold harmless Simmons College, its officers, employees
and agents from any and all costs, liabilities, expenses, claims, demands or causes of action on account of any loss
or personal injury that might result from my non-compliance with the recommendation of the NCAA and
Simmons College. I am fully aware of the risks and hazards associated with refusing this testing.
I have read and signed this document with the full knowledge of its significance. I further state that I am at least
18 years of age.
Student-Athlete Signature: _________________________________________________ Date: _____
Parent/Guardian Signature (if under 18 years of age): __________________________ Date: _____
Parent/Guardian (Print Name): ________________________________________________________