Registration And Participation Consent Form (Page 2 of 2) in pdf

Registration And Participation Consent Form Page 2

Parent and Athlete Agreement

Parent Agreement

As a Parent and as an Athlete it is important to recognize the signs, symptoms, and behaviors of concussions. By signing

this form you are stating that you understand the importance of recognizing and responding to the signs, symptoms, and

behaviors of a concussion or head injury. Parent Agreement: I _________________________________ have read the

Parent Concussion and Head Injury Information and understand what a concussion is and how it may be caused. I also

understand the common signs, symptoms, and behaviors. I agree that my child must be removed from practice/play if a

concussion is suspected. I understand that it is my responsibility to seek medical treatment if a suspected concussion is

reported to me. I understand that my child cannot return to practice/play until providing written clearance from an

appropriate health care provider to his/her coach. I understand the possible consequences of my child returning to

practice/play too soon.

Parent Signature

Date

Athlete Agreement

Athlete Agreement: I_______________________________ have read the Athlete Concussion and Head Injury

Information and understand what a concussion is and how it may be caused. I understand the importance of reporting a

suspected concussion to my coaches and my parents/guardian. I understand that I must be removed from practice/play

if a concussion is suspected. I understand that I must provide written clearance from an appropriate health care provider

to my coach before returning to practice/play. I understand the possible consequence of returning to practice/play too

soon and that my brain needs time to heal.

Student Signature

Date

Registration And Participation Consent Form Page 2