Please read the agreement below, then either digitally sign below and send the form – or download the PDF version  for mail or hand delivery.

I, the parent/guardian of the student listed below, acknowledge that I have received information on all of the following:

  • The definition of a concussion
  • The signs and symptoms of a concussions to observe for or that may be reported by my athlete
  • How to help my athlete prevent a concussion
  • What to do if my athlete has a concussion, specifically, to seek medical attention immediately, keep my athlete out of play, tell the coach about a recent concussion, and report any concussion and/or symptoms to the school nurse.


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