* Required

Parent Concussion Form 2022-23

Parent/Guardian 1

Parent/Guardian 2

Student Athlete Information

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.

Type your first and last name, to be used as your electronic signature.​