Form
We have received the information provided on the concussion fact sheet titled, “HEADS UP: Concussion in High School Sports.”
IMPORTANT: Students participating in interscholastic athletics, cheerleading and dance; and their parents/guardians; must annually sign the acknowledgement below and return it to their school. Students cannot practice or compete in those activities until this form is signed and returned.
Student's Name
First Name
Last Name
Student's Signature
Parent's Name
First Name
Last Name
Parent's Signature
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