Minnesota State University - Mankato Athletics

I,____________________________________ (Student-athlete name) attest that I have insurance coverage under a current in force insurance policy for injuries that occur during my participation in intercollegiate athletics. If there is a material change in coverage or expiration of coverage, I agree to notify Minnesota State University, Mankato of this development and update the insurance information I have on file with Minnesota State University, Mankato. I further understand and agree that failure on my part to notify Minnesota State University, Mankato of insurance changes will result in no responsibility whatsoever for the payment of, or authorization to pay, medical expenses resulting in injuries that occur while participating in intercollegiate athletics at Minnesota State University, Mankato