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WHAT'S NEW? You will now log in to MyPJC with your Dragonmail email address.

Standardized Email Format: First initial + Last name + Last 4 digits of your Student ID (e.g., jdoe1234) (length limited to 20 alphanumeric characters)
Example Email Address: jdoe1234@dragons.parisjc.edu
Initial Password: Your 8-digit date of birth (mmddyyyy)
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Athletics

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Athletic Packet Checklist
PJC Insurance Policy
Parent's Insurance Form

RETURNING STUDENT ATHLETE PACKET: CHECKLIST

***Forms must be filled out and on file by August 1, 2025.***

Returning Student-Athlete check List:

Parent’s Insurance Information Sheet (All student-athletes must have a valid primary insurance, Paris Junior College is a secondary insurance only)
Medical Report (Yearly Physical – Must be taken after June 1st)
Financial Aid Application (Can be filled out at www.fafsa.ed.gov – must be done by ALL student athletes receiving aid whether you are eligible or not)

Which sport do you play?

Which sport do you play?

Men's Basketball
Women's Basketball
Men's Soccer
Women's Soccer
Softball
Baseball
Cheer

Required Documents (.pdf .doc & .docx format only)

Please download the Physical Exam using the link down below and upload it to your pack once complete.

Physical Examination Form

Choose a file

RETURNING STUDENT ATHLETE PACKET: PJC INSURANCE POLICY

All student-athletes MUST have a primary insurance carrier – Paris Junior College is a secondary insurance only

Paris Junior College insurance coverage is “EXCESS” or “SECONDARY” to any other collectible group insurance benefits. This means that any claim for benefits must first befiled with the group insurance company providing coverage to you, most notable by parental coverage. After your primary insurance has paid all available benefits, our athletic insurance company will consider remaining amounts based on USUAL and CUSTOMARY charges within two years of the initial injury date. It is required that each student-athlete’s parent/guardian fill out and sign an insurance form and return it to the Athletic Department to be kept on file. The parent information form will contain information regarding the student’s insurance coverage, including address and phone number of the insurance company, policy number, etc. This information should be given to the provider each time an athlete is taken for medical treatment.

If your insurance plan requires you to obtain a referral from your designated Primary Care Physician (PCP) the referral must be obtained prior to seeking medical services at the medical facilities that Paris Junior College Uses.

Paris Junior College has no responsibility for any pre-existing condition that the athlete has experienced prior to joining the college athletic program. This includes treatment, by physicians, chiropractors and prescription drugs and medications.

The following outlines steps to follow in order to complete the claims process with ease:

1. Any and all injuries must be reported to the coach and evaluated by the PJC athletic trainer to determine if further medical treatment or evaluation is necessary.

2. If further treatment is sought, all appointments will be made by the PJC sports medical staff or coach.

RETURNING STUDENT ATHLETE PACKET: PARENT'S INSURANCE FORM

Athlete's Name:

SSN:

Sport:

School:

Athlete's Email:

Dear Parent:

Our athletic accident policy, which provided Insurance for your son or daughter for Injuries occurring while participating in the play or practice of Intercollegiate sports Is "EXCESS" or "SECONDARY" to any other collectible group Insurance benefits. All Paris Junior College Student/Athletes must have Insurance before enrollment at Paris Junior College. This means that any calm for benefits must first be filed with the group Insurance company providing coverage to your son or daughter through our employer or your spouse's employer. After they have paid all available benefits, our athletic Insurance company will consider remaining amounts based on USUAL and CUSTOMARY charges.

WE, AS A SCHOOL, DO NOT HAVE THE OPTION OF WAIVING THE REQUIREMENT OF FILING WITH YOUR GROUP INSURANCE.

PLEASE NOTE:

1. Most employer's group Insurance allows dependent coverage to be continued to age 25 If the dependent Is a full-time student. DO NOT drop dependent coverage while your son or daughter Is participating In Intercollegiate athletics.

2. Claims against your group insurance plan DO NOT increase your individual Insurance premiums.

THE FOLLOWING INFORMATION AND AUTHORIZATION MUST BE FULLY COMPLETED, SIGNED AND RETURNED; please choose the Individual listed as the Insured on your primary/personal plan and complete all requested Information.

Choose One:

Choose One:

Father
Guardian
Spouse
Self

Date of Birth:

Name:

SSN:

Home Address:

Employer's Name:

Employer's Address:

Home/Cell Phone #:

Work Phone #:

Name of Group Insurance Company:

Group #:

Policy #:

Mailing Address for Claims:

Phone #:

IS YOUR DEPENDENT SON/DAUGHTER COVERED UNDER THE ABOVE POLICY?

IS YOUR DEPENDENT SON/DAUGHTER COVERED UNDER THE ABOVE POLICY?

Does your insurance require: A second opinion for surgery?

Does your insurance require: A second opinion for surgery?

Is your primary insurance an HMO?

Is your primary insurance an HMO?

Pre-authorization for services?

Pre-authorization for services?

Is your primary insurance a PPO?

Is your primary insurance a PPO?

Choose One:

Choose One:

Mother
Guardian
Spouse
Self

Date of Birth:

Name:

SSN:

Home Address:

Employer's Name:

Employer's Address:

Home/Cell Phone #:

Work Phone #:

Name of Group Insurance Company:

Group #:

Policy #:

Mailing Address for Claims:

Phone #:

IS YOUR DEPENDENT SON/DAUGHTER COVERED UNDER THE ABOVE POLICY?

IS YOUR DEPENDENT SON/DAUGHTER COVERED UNDER THE ABOVE POLICY?

Does your insurance require: A second opinion for surgery?

Does your insurance require: A second opinion for surgery?

Is your primary insurance an HMO?

Is your primary insurance an HMO?

Pre-authorization for services?

Pre-authorization for services?

Is your primary insurance a PPO?

Is your primary insurance a PPO?

Copy of student insurance card

Choose a file

I hereby certify that the answers provided are true, complete and correct to the best of my knowledge. I authorize release of the above insurance information to any concerned providers. A photostatic copy of this authorization shall be considered as effective and valid as the original.

I hereby certify that the answers provided are true, complete and correct to the best of my knowledge. I authorize release of the above insurance information to any concerned providers. A photostatic copy of this authorization shall be considered as effective and valid as the original.

I Certify

Date:

Date