Concussion Form

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Concussion Form

Please read the concussion document below, then acknowledge that you have read and understand the document fully by completing the questions and signatures following the document.

Email *

Concussion Form - Page 1

Concussion Form - Page 2

*You will receive an email with your responses when you submit this form online and a paper copy upon request.

Parent/Guardian Name *

Athlete Name *

Sport *

Select a Sport from the dropdown menu

School Name *

I have reviewed the contents of the packet with my son/daughter and I agree and understand that by typing my name below that this form of electronic signatures have the same legal force and effect as a manual signature.

Parent Signature *

Athlete Signature *

Date Signed *

YYYY

A copy of your responses will be emailed to the address you provided.

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