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. Completed forms must be submitted to David Rodriguez, UCLA Insurance Coordinator, one of three ways:

1. Fax : (310) 206-1985
2. USPS Mail:

Acosta Athletic Training Room, attn David Rodriguez
PO Box 24044
Los Angeles, CA 90024-0044

3. Scan and Email:

 2015-16 Medical Insurance Forms (Incoming Student-Athlete)
 2015-16 Medical Insurance Forms (Returning Student-Athlete)

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 

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