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CONCUSSION AND SUDDEN CARDIAC ARREST INFORMATION AND SIGNATURE FORM PARENTS/GUARDIANS AND STUDENT ATHLETES Name (Please Print): School Year: 202021Grade: 67891011 12 Please Circle: M or Sport IC 20347
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01
To fill out the concussion form, follow these steps:
02
Begin by filling out your personal information section, including your name, date of birth, and contact information.
03
Provide details about your medical history, such as any previous concussions or related injuries.
04
Answer the questions about your current symptoms, including any physical, cognitive, or emotional changes you may have experienced after the injury.
05
If applicable, provide information about the incident that caused the concussion, such as the date, location, and any witnesses.
06
If required, attach any supporting documents, such as medical reports or test results.
07
Review the filled form for completeness and accuracy before submitting it.
08
To fill out the sudden cardiac form, follow these steps:
09
Start by entering your personal information, including your name, age, and contact details.
10
Provide details about your medical history, specifically any cardiovascular conditions or previous incidents related to sudden cardiac events.
11
Answer the questions regarding your current condition, including any symptoms or warning signs you may have experienced.
12
If applicable, provide information about any medications you are currently taking or any previous treatments received for cardiovascular issues.
13
Include information about any family history of sudden cardiac events, if known.
14
Review the form to ensure all necessary information has been provided and make any necessary revisions before submission.

Who needs concussion and sudden cardiac?

01
Concussion form is typically needed for individuals who have suffered a head injury or suspected concussion, such as athletes involved in sports or people who have been in accidents.
02
Sudden cardiac form is generally required for individuals with a history of cardiovascular conditions or those who might be at risk for sudden cardiac events, including individuals with certain medical conditions or a family history of such events.
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Concussion is a mild traumatic brain injury that can occur from a blow or jolt to the head. Sudden cardiac arrest is when the heart suddenly stops beating effectively.
Coaches, athletic trainers, and school officials are required to file concussion and sudden cardiac forms for student-athletes.
Concussion and sudden cardiac forms can be filled out online or on paper, providing information about the student-athlete's medical history and any past incidents.
The purpose of filing concussion and sudden cardiac forms is to ensure the safety of student-athletes participating in sports by identifying and addressing any potential health risks.
Information such as the student-athlete's medical history, past incidents of concussion or sudden cardiac, and any relevant family medical history must be reported on the forms.
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