Release Form – Sickle Cell Trait Test
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Sickle cell trait is the inheritance of an abnormal gene which can cause deformation (“sickling”) of the red blood cell, along with a normal gene for hemoglobin. Approximately one in every 12 African-
Americans has sickle cell trait, (compared to ~ one in 2,000 to 12,000 white Americans). The gene for sickle cell trait is also present in individuals of Mediterranean, Middle Eastern, Indian, Caribbean and
South / Central American ancestry. All newborns in the U.S. are required to be screened for sickle cell.
Sickle cell trait has been associated with rhabdomyolysis, renal failure, as well as death, and complicating factors include extreme exertion, increased heat, altitude, & dehydration. Over a nine year span, seven athletes participating in NCAA sports died as a complication of sickle cell trait. It is because of this that the NCAA has now mandated testing or proof of testing prior to any practice, competition or conditioning.
Effective beginning the 2013-2014 academic year, all NCAA Division III student-athletes, as part of their required medical examination or evaluation, must be tested for sickle cell trait, provide the institution with proof of a prior test, or sign a waiver declining to be tested.
Why get tested? The sickle cell trait test (SST) is relatively easy to perform, and can provide educational information that can be helpful to you both on and off the field. It is helpful to know your sickle cell status and can allow health care professionals to take better care of you. If you were born in the U.S., your testing results may be available in your medical record.
What happens if I test positive? Athletes that are sickle cell trait positive are able to participate in sports, often with no modifications whatsoever. Individuals that test positive for sickle cell trait will have a confirmatory test performed, and if positive, will be counseled on what can be done to avoid complications.
Who will know that I test positive? The medical staff needs to be aware of your sickle cell status in order to provide optimal care of you during practice, competition and conditioning. Outside of this, you will be asked if and who this information can be released to.
Is it mandatory that I have the sickle cell trait test? The recommendation is that every student-athlete be tested or show proof of prior testing for sickle cell trait. If you have not had the test and wish to be
tested, you should arrange to be tested prior to arriving on campus. Testing is not mandatory.
For more information please see the attached fact sheet for student-athletes or visit www.ncaa.org/wps/wcm/connect/public/NCAA/health+and+Safety/Sickle+Cell+Landing+Page

NOTE: NCAA rules do not permit student-athletes to practice with their team until the results of the test have come in. Please also be aware that if you come to Bates College and wish to be tested, you will not be cleared to practice/participate until the test results are available. This will delay your participation in your sport.
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Prior to arriving on campus please complete, sign and return the waiver below to:
Bates College
31 Campus Ave
Lewiston, ME 04240
Fax #: 207-786-8240
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I __________________________________hereby acknowledge that I have received and understand the information that Bates College has provided to me regarding testing for the sickle cell trait as well as the recommendation from Bates College that testing be performed. I understand that I am required to be tested or provide proof of prior testing for the sickle cell trait, or, if I decline to be tested, to sign a written waiver and release.
Based on the information above please check one of the following:
________ I have been tested for the Sickle Cell Trait and a copy of my test results is attached.
Please also provide the following:
Date:_________ Location:____________________________________________________
Name of Physician:_______________________________Results:_____________________
_________ I agree to Testing and have scheduled an appointment with my physician or a local
Lewiston, ME clinic on_____________ to have the SST administered.
_________ I decline to be tested and have chosen to decline testing with the knowledge that I may
have undiagnosed sickle cell trait or disease, and this may lead to an increased risk of
injury or death related to athletic activities. I hereby release Bates College, including its
Athletics Department, Team Physicians, Athletic Training staff and associated medical
professionals from any liability related to my sickle cell status. This waiver and release is
intended to be legally binding.
Printed Name of Student:_____________________________________ Date of Birth:_______________
Signature of Student:____________________________________ Sport:______________Date:________
Signature of Parent (required if student is under 18):___________________________ Date:__________
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