2023-2024 CONCUSSION AWARENESS ACKNOWLEDGEMENT FORM IN COMPLIANCE WITH MICHIGAN PUBLIC ACTS 342 AND 343 OF 2012

CONCUSSION AWARENESS ACKNOWLEDGEMENT FORM IN COMPLIANCE WITH MICHIGAN PUBLIC ACTS 342 AND 343 OF 2012
Dear Parents/Guardians,

On July 1, 2013 two new bills became law. Public Act 342 and Public Act 343, commonly referred to as concussions in young athletes, require all parents to sign a form acknowledging they have been given a fact sheet, list of symptoms, and protocol for returning after exhibited symptoms of a concussion. Holy Family is requiring all parents to sign this sheet acknowledging receipt of the previously mentioned materials for your child to participate in gym, recess, athletics, or any activity where a concussion could occur. Please see to the following resources:

http://www.legislature.mi.gov/(S(uykxbu455b13fi45i20bqg45))/mileg.aspx?page=getobject&objectname=2012-SB-1122

http://www.cdc.gov/concussion/HeadsUp/youth.html

http://hfssports.com (our Athletic Booster's website)

By the names and signatures below, we acknowledge in accordance with Public Acts 342 and 343 of 2-12 that we have received and reviewed the information regarding concussions provided by Holy Family Catholic School, Grand Blanc, MI.
Student's Name #1*

First NameLast Name
Student's Signature #1*
Student's Name #2

First NameLast Name
Student's Signature #2
Student's Name #3

First NameLast Name
Student's Signature #3
Student's Name #4

First NameLast Name
Student's Signature #4
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian's Signature*
Should be Empty: