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CONCUSSION and SUDDEN CARDIAC ARREST ACKNOWLEDGEMENT AND SIGNATURE FORM FOR PARENTS AND STUDENT ATHLETES Name (Please Print): Sport Participating In (Current and Potential): School: Grade: IC 20347
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Start by entering the date and your full name in the designated spaces at the top of the form.
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Read through the concussion- signature form carefully to understand the information and requirements.
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Provide your contact information, such as phone number and email address, in the specified fields.
04
Review the provided list of concussion symptoms and indicate whether you have experienced any of them.
05
Sign and date the form at the bottom to acknowledge that you have read and understood the concussion information.
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If required, provide any additional details or information requested on the form.
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Double-check all the filled-out information for accuracy before submitting the form.

Who needs concussion- signature form with?

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Concussion- signature form is typically needed by individuals who have experienced a concussion or those who participate in activities prone to head injuries. This form helps gather relevant information about the individual's symptoms and serves as an acknowledgment of understanding the risks associated with a concussion.
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The concussion signature form is a document used to acknowledge the understanding of concussion risks and protocols, often required in sports or academic settings.
Participants, including athletes, parents, and coaches, are typically required to file the concussion signature form.
To fill out the concussion signature form, individuals usually need to provide personal information, signatures, and date of completion, verifying their understanding of the concussion policies.
The purpose of the concussion signature form is to ensure that all parties are aware of the risks associated with concussions and to promote safe practices in the event of a head injury.
Information typically required includes the participant's name, date of birth, a parent or guardian's name, signatures, and acknowledgment of concussion protocols.
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