Medical Insurance Forms

Medical Insurance Forms are to be completed annually by all UCLA incoming and current student-athletes. Try-out athletes do not need to complete these forms.

To request Medical Insurance Forms, please send an e-mail to David Rodriguez, Medical Insurance Coordinator, at: drodriguez@athletics.ucla.edu

Include the following information:

1. Full name of student-athlete
2. Sport of student-athlete
3. E-mail of student-athlete
4. Full name of parent/guardian
5. E-mail of parent/guardian

Medical Clearance Form for Try-Out Student Athletes

In order to try-out for an athletic team, you must be currently enrolled at UCLA. In order to be eligible to try-out for a team, the Medical Clearance Form must be completed by a physician after performing a pre-participation physical. The form must be signed by the physician, indicating you are medically cleared to participate. Students are allowed to participate in UCLA team activities for a maximum of 2 weeks from the first practice or try-out session.

Medical Clearance Form for Try-Out Student-Athletes