Head Athletic Trainer
760-757-2121 ext. 6427
Preparticipation physical exams will be conducted by the team physician and the sports medicine team for prospective MiraCosta College athletes at the Athletic Training Room, OC 5106, at a date and time to be announced, at no charge. Please be on time and do not exercise prior to the exam.
All student athletes are required to complete a preparticipation physical exam prior to any tryouts, practices or any intercollegiate team functions. If you are interested in participating in a sport at MiraCosta College, but are unable to attend the on campus screening exams, please prepare the following three documents (the form titled Sports Preparticipation Physical Exam will need also to be completed by your primary care physician or another examining physician) and submit them to the Athletic Trainer prior to the first day of participation. If you have any questions, contact the Athletic Trainer, Alyssa Jacobs, at 760.757.2121 x6427.
- Sports Preparticipation Physical Exam (PDF)
Please fill out the first page in its entirety. If you do not have personal insurance, indicate so by writing "none". You also need to fill out the top of the second page and then sign and date (only once.) This form will also need to be signed by your parent or legal guardian if you are under 18 years of age. The portion below the signature box on the second page - Medical Examination Record - is to be filled out the physician(s) conducting the pre-participation physical and dated and signed, including the physician(s) contact information. Please include a front & back copy of your medical insurance card.
- Athletic Emergency Information (PDF)
Please fill out the information as indicated. If no personal insurance or no additional medical information, indicate so by writing "none". If you are under 18 years of age, this document will also need to be signed by your parent or legal guardian. A copy of this document will be included in the travel medical kit for emergencies.
- Liability Release and Waiver Agreement (PDF)
Please fill out the information as indicated. If you are under 18 years of age, this document will also need to be signed by your parent or legal guardian.
Erik Stark , M.D.
Specializes in sports medicine, cartilage repair, patella-tendon repair, and knee surgery at Orthopaedic Specialists of North County.
3905 Waring Road
MiraCosta College Athletes: contact Alyssa Jacobs, Athletic Trainer, for referral