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Required
Parent Concussion Form 2022-23
Parent/Guardian 1
First Name
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required
Last Name
*
required
Email
*
required
Phone
*
required
Do you wish to enter contact information for a second parent/guardian?
Yes
No
Parent/Guardian 2
First Name
Last Name
Email
Phone
Student Athlete Information
Athlete First Name
*
required
Athlete Last Name
*
required
Parent Concussion/SCA Acknowledgement
I, as the parent or legal guardian of the above named student, have received and read the Parent Information Fact Sheets for concussion/head injury and sudden cardiac arrest. I understand the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury. I also understand the symptoms of Sudden Cardiac Arrest.
Yes, I agree with the above statement.
*
required
Type your first and last name, to be used as your electronic signature.
Please send a confirmation email to the address below*: