2016 Student-Athlete Medical Forms

D'Youville College student-athletes are required to provide annual medical physicals and insurance information that includes coverage for athletically-related injuries. This is a pre-requisite for practice and competition. No student will be allowed to participate, in any way, until such evidence of current insurance coverage and medical information is on file with the D'Youville College Department of Athletics.

The attached packet needs to be reviewed and completed along with a clear photocopy of both sides of a current insurance card before a student can be allowed to participate.

2016-17 Student-Athlete Participation Forms


This applies to ALL returning student-athletes, incoming freshmen, and transfers.


The NCAA's Catastrophic Injury Insurance Program covers student-athletes who are catastrophically injured while participating in a covered intercollegiate athletic activity (subject to all policy terms and conditions). This coverage does not qualify as the basic coverage required for participation in athletics at D'Youville College. More information on this program can be found at by following this link to the NCAA website.

Please submit (by mail) the completed attached forms along with a copy of both sides of your current insurance card to the D'Youville College Department of Athletics by August 1, 2015.

Please mail all forms to:

Kevin Pullyblank
Head Athletic Trainer
329 Porter Ave
Buffalo, NY 14201

Fax Number: (716) 829-8272

If you have any questions regarding this requirement please contact Brian Cavanaugh, Director of Athletics at cavanaub@dyc.edu or (716) 829-7878.