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Revised June 2013CONCUSSION ACKNOWLEDGEMENT FORM Name of Student Definition of Concussion means a complex pathophysiological process affecting the brain caused by a traumatic physical force or impact

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How to fill out concussion acknowledgement form

01

Step 1: Begin by reading the concussion acknowledgement form carefully.

02

Step 2: Fill in your personal details such as name, date of birth, address, and contact information.

03

Step 3: Provide information about your school, college, or organization.

04

Step 4: Read and understand the concussion symptoms and potential risks section.

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Step 5: Sign and date the form to acknowledge your understanding and acceptance of the concussion risks and symptoms.

06

Step 6: Submit the completed form to the appropriate person or department.

Who needs concussion acknowledgement form?

01

Athletes participating in sports activities.

02

Students attending schools or colleges with sports programs.

03

Employees working in organizations that have physical activities involving potential head injuries.

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What is concussion acknowledgement form?

The concussion acknowledgement form is a document that acknowledges the risks and symptoms of a concussion and is typically signed by athletes, coaches, and parents.

Who is required to file concussion acknowledgement form?

Athletes, coaches, and parents are usually required to file the concussion acknowledgement form.

How to fill out concussion acknowledgement form?

The form typically requires individuals to provide their personal information, sign a statement acknowledging the risks of a concussion, and provide emergency contact information.

What is the purpose of concussion acknowledgement form?

The purpose of the concussion acknowledgement form is to inform individuals about the risks of concussions and to ensure that they are aware of the symptoms and proper protocol for reporting a concussion.

What information must be reported on concussion acknowledgement form?

Personal information, acknowledgement of risks, emergency contact information.

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