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CONCUSSION INFORMATION AND SIGNATURE FORM FOR STUDENTATHLETES & PARENTS/LEGAL GUARDIANS (Adapted from CDC Heads Up Concussion in Youth Sports)Read and keep this page. Sign and return the signature

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How to fill out concussion information and signature

01

Start by gathering all the necessary information about the concussion.

02

Make sure to include the date and time of the incident.

03

Note down any symptoms experienced by the person with the concussion.

04

Document any medical treatment received or recommended for the concussion.

05

Provide any additional relevant details about the incident or the person's condition.

06

Sign and date the concussion information form to indicate its accuracy.

07

Ensure that all required fields are filled out correctly.

08

Submit the completed concussion information and signature form to the appropriate recipient.

Who needs concussion information and signature?

01

Anyone who has suffered a concussion and is seeking medical attention or treatment.

02

Sports organizations and schools may also require concussion information and signature for their records.

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What is concussion information and signature?

Concussion information and signature is a form that provides details on a student's concussion history and requires a signature to acknowledge understanding.

Who is required to file concussion information and signature?

Parents/guardians of student-athletes are required to file concussion information and signature.

How to fill out concussion information and signature?

Concussion information and signature can be filled out by providing accurate details about the student's concussion history and signing the form to acknowledge understanding.

What is the purpose of concussion information and signature?

The purpose of concussion information and signature is to ensure that parents/guardians are aware of their student-athlete's concussion history and understand the risks.

What information must be reported on concussion information and signature?

Concussion information and signature requires details on any past concussions, symptoms experienced, and treatment received.

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