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Concussion Protocol Parent/Guardian Acknowledgement Form Season: Affiliate: Athlete Name (Print): Program: Level of Play: 1. I understand that the Pacific District of USA Hockey has adopted concussion
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Obtain the concussion protocol parent/guardian acknowledgement form.
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Read through the form carefully to understand the information and requirements.
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Fill out the form accurately and completely.
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Who needs concussion protocol parentguardian acknowledgement?

01
Any parent or legal guardian of a minor participating in activities or sports that involve a risk of head injury.
02
Schools, sports clubs, and other organizations may require this acknowledgement to ensure that parents/guardians are aware of the risks and protocols for handling concussions.
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The concussion protocol parentguardian acknowledgement is a form signed by a parent or guardian acknowledging the risks and procedures related to concussions in sports.
All parents or guardians of student athletes participating in sports are required to file concussion protocol parentguardian acknowledgement.
To fill out the concussion protocol parentguardian acknowledgement, parents or guardians must read the information provided, sign the form, and submit it to the appropriate school or sports organization.
The purpose of concussion protocol parentguardian acknowledgement is to ensure that parents and guardians are aware of the risks of concussions in sports and the procedures to follow in case of a suspected concussion.
The concussion protocol parentguardian acknowledgement typically requires basic information such as the student athlete's name, sport(s) participated in, parent/guardian contact information, and signatures.
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