ASHLAND UNIVERSITY
Student Health Center
SICKLE CELL TRAIT
Information and Documentation Form
To insure a healthier athletic experience for each of our student athletes, the NCAA is requiring that
sickle cell trait testing is offered to all student athletes. Sickle cell trait is a hereditary condition that can
affect the shape of red blood cells during intense exercise. These deformed red blood cells can
accumulate in the bloodstream, blocking normal blood flow to muscles and tissue. During intense
exercise, athletes with sickle cell trait can experience significant physical distress, collapse and even die.
In order to provide better medical care for athletes that have sickle cell trait, the NCAA recommends that
all athletes know their sickle cell trait status. A quick fact sheet from the NCAA regarding sickle cell trait
is provided at http://fs.ncaa.org/Docs/health_safety/SickleCellTraitforSA.pdf for your reference.
The testing (blood work) for sickle cell trait is not mandatory, but highly encouraged. However,
documentation of your choice is mandatory. Each student athlete has one of three options regarding
sickle cell trait testing. Please take time to review the fact sheet and check the option below that best fits
your needs. Please print your name on the line provided by your choice.
I,
would like to have the testing for sickle cell trait done through
the Ashland University Student Health Center. There is no fee for this testing.
I,
have provided proof of prior sickle cell trait testing to be added
to my medical file at Ashland University.
I, _________________________ have elected not to proceed with testing for sickle cell trait. I
have read the literature provided by the NCAA and Ashland University. By signing this waiver I
release the NCAA, Ashland University, and all employees of Ashland University of any
responsibility or liability involving negative outcomes which may result from this decision.
Student Athlete’s Signature
Date
Parent/Guardian Signature (if athlete under 18 years of age)
Date
Witness Signature
Date
Please return your completed form to the Student Health Center prior to your arrival on campus
by mailing to Ashland University Student Health Center, 401 College Avenue, Ashland, Ohio 44805 or
fax to (419) 289-5209.
If you have any questions, please do not hesitate to contact the Student Health Center at (419) 289-5200.