Athletic Medical Forms

Greetings Bulldog Athletes:

The Union College Sports Medicine Department would like to welcome all of you to campus as we approach the beginning of another exciting year of Bulldog Athletics. In an effort to reduce the amount of paperwork you will need to complete during the preseason physical exams, we have made our insurance forms available online. The links below will direct you to these downloadable documents. These documents require either Microsoft Word or Adobe Acrobat Reader to access them. You may enter your information in the text boxes located on the "electronic" version by using the "tab" button to jump from box to box. Once you have completed this form: print the document; complete pages 2-4 (Please Note: if you are under 18 years of age, your parent or legal guardian must also sign these pages); and keep pages 5-6 for your records. These documents must be completed prior to the beginning of every school year. If you wish, you may save a copy of this completed form to your hard-drive and edit any changes to your information in the years to come by selecting "File" then "Save As". If you have any difficulty entering your information in the "electronic" version of this form, you may access the "print" version and complete this document by hand.

If you have any problems or questions with these forms, please feel free to contact Clay Butler, MA, ATC at (606) 546-1303 or by email at [email protected]. Once you have completed this document, please staple the pages together and mail them to Ms. Lana Faulkner, the Union College Athletic Insurance Coordinator, at the address listed on the form no later than August 1, 2013. We hope you have had an enjoyable summer, and we look forward to assisting you during your athletic career at Union College.


Clay Butler, MA, ATC
Head Athletic Trainer
Union College Sports Medicine

Electronic Form - in Microsoft Word
Print Form - in Microsoft Word
Print Form - in Adobe Acrobat Reader