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CONCUSSION ACKNOWLEDGEMENT AND SIGNATURE FORM FOR PARENTS AND STUDENT ATHLETES Name (Please Print): ___ Sport Participating In (If Known): ___ Date: ___ IC 20347 Student Athletes: Concussions and
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01
Start by obtaining a concussion acknowledgement and signature form.
02
Provide necessary information, such as name, date of birth, and contact details.
03
Read the entire form carefully to understand the concussion risks and potential consequences.
04
If you have any questions or concerns, consult a healthcare professional or the concerned authority.
05
Sign the form to indicate that you have understood the risks and consequences associated with concussions.
06
Submit the form to the appropriate authority or institution.
07
Keep a copy of the signed form for your records.

Who needs concussion acknowledgement and signature?

01
Anyone participating in activities or sports that carry a risk of concussions may need to fill out a concussion acknowledgement and signature. This could include athletes, students, employees, or volunteers involved in contact sports, physical education programs, recreational activities, or certain workplace environments where head injuries are possible.
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Concussion acknowledgement and signature are forms that individuals must fill out to acknowledge their understanding of the risks of concussion and agree to comply with the concussion protocol.
Athletes, coaches, and parents/guardians of minors are required to file concussion acknowledgement and signature.
Individuals can fill out the concussion acknowledgement and signature forms by providing their personal information, acknowledging the risks of concussion, and signing to indicate their agreement with the concussion protocol.
The purpose of concussion acknowledgement and signature is to ensure that individuals are aware of the risks of concussion, understand the concussion protocol, and agree to comply with the necessary procedures.
The information reported on concussion acknowledgement and signature forms typically includes personal details of the individual, acknowledgement of concussion risks, and agreement to comply with the concussion protocol.
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