* Required

Student Concussion Form

Athlete Information

What number should coaches use to communicate practice and game information?​​​
(i.e.: Cross Country, Golf, Soccer, Tennis or Volleyball)​
(i.e.: Basketball, Cheerleading or Swim/Dive)​
(i.e.: Baseball, Golf, Softball, Tennis or Track)​

Student Concussion/SCA Acknowledgement

I am a student athlete, participating in the above mentioned sport. I have received and read the Student Athlete 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. Please type your electronic signature in the field provided below.
Type your first and last name, to be used as your electronic signature.​