Athletic Consent Form - Cedar Hill Prep School (Page 3 of 4) in pdf

Athletic Consent Form - Cedar Hill Prep School Page 3

ATHLETIC PARENTAL CONSENT FORM

N.J.S.A.A. CONCUSSION POLICY ACKNOWLEDGEMENT FORM

We have received and reviewed the N.J.S.A.A. concussion policy acknowledgment form and understand

the facts, signs and symptoms of a concussion, as well as the basic guidelines for the concussion

management protocol.

Student’s Signature: ________________________________________ Date: ________________

Parent’s Signature: _________________________________________ Date: ________________

SUDDEN CARDIAC DEATH BROCHURE

We have received and reviewed the sudden cardiac death in young athletes pamphlet and understand the

basic facts of sudden cardiac death in young athletes. We are also aware of additional resources available

on this subject from the American Heart Association ( ) and the Hypertrophic

Cardiomyopathy Association ( ).

Student’s Signature: ________________________________________ Date: ________________

Parent’s Signature: _________________________________________ Date: ________________

MEDIA COVERAGE

I hereby grant permission for the release of videotapes, audio recordings, and photographs that could

identify my child by name, to the school and the media for the use in various media outlets including

but not limited to news stories, websites and social media outlets, as it pertains to my child and

Cedar Hill Prep School Athletics. I also grant permission for my child to be interviewed by the school

and the media as it pertains to Cedar Hill Prep School Athletics.

Student’s Signature: ________________________________________ Date: ________________

Parent’s Signature: _________________________________________ Date: ________________

Athletic Consent Form - Cedar Hill Prep School Page 3