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CONCUSSION ACKNOWLEDGEMENT & SIGNATURE FORM PARENTS & STUDENT ATHLETES Name (Please Print): Date: Due to B197: Athletic Concussion Protection Act of 2011, DC STODDARD SOCCER is required to distribute

How to fill out concussion acknowledgement amp signature

How to Fill Out Concussion Acknowledgement & Signature:

1. Obtain the necessary forms: Begin by obtaining the concussion acknowledgement and signature forms from the appropriate organization or institution. These forms are typically provided by schools, sports teams, or employers.
2. Read the instructions: Carefully read through the instructions provided on the forms. Pay attention to any specific requirements or guidelines that may need to be followed while filling out the forms.
3. Provide personal information: Fill out your personal information accurately and completely. This typically includes your full name, date of birth, address, contact information, and any other relevant details that may be required.
4. Review the concussion information: Read through the concussion information provided on the form. This section usually includes details about the signs, symptoms, and potential risks associated with concussions. It is important to understand this information thoroughly.
5. Acknowledge understanding: Sign or check the box that indicates your understanding of the concussion information provided. This step confirms that you have read and understood the risks and consequences associated with concussions.
6. Consent for treatment: If applicable, consent may also be required to authorize medical professionals to provide necessary treatment in the event of a concussion. Read the consent section carefully and sign or check the appropriate box as required.
7. Additional signatures: Some forms may require additional signatures, such as that of a parent or guardian for minors. Make sure to follow the instructions regarding additional signatures if necessary.

Who Needs Concussion Acknowledgement & Signature?

1. Athletes: Athletes participating in organized sports are often required to fill out concussion acknowledgement and signature forms. This is to ensure awareness of concussion risks and to obtain consent for appropriate treatment if needed.
2. Students: Schools may require concussion acknowledgement and signature forms for students participating in physical education classes, sports teams, or extracurricular activities. This helps ensure awareness of concussion risks and potential actions to be taken in case of an injury.
3. Employees: Some workplaces, especially those with physically demanding jobs or potential risk of head injuries, may require employees to fill out concussion acknowledgement and signature forms. This is to ensure that employees are aware of safety precautions and the potential risks associated with concussions while on the job.

Note: The specific individuals or groups requiring concussion acknowledgement and signature forms may vary based on the policies and regulations of each organization or institution. Always refer to the specific requirements provided by the relevant authority.

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