Maryville Junior High School 2025 GKTA Middle School Tennis League Player/Parent Consent Forms

2025 GKTA Middle School League Player Information and Parental Consent Forms

Student-Athlete & Parent/Legal Guardian Concussion Statement
Player's Name*
School*
Grade (Fall 2025)*
Age*
Birthdate*

MonthDayYear
Date
USTA Number*
Expiration Date*

MonthDayYear
Date
World Tennis Number (if you do not know, please put ?)*
Address*

Address

Street Address Line 2

CityState

Zip.
Home Phone*
E Mail*
example@example.com
Cell*
Parents/Guardians Name(s)*
Home Phone*
E Mail*
example@example.com
Cell*
I am the parent/guardian of the above named candidate for position in above recreational tennis program, and hereby give approval to her/his participation in any and all league activities during the current season. I assume all risk and hazards incidental to such participation including transportation to and from activities and do hereby waive, release, absolve, indemnify and agree to hold harmless the parent or local league organizer and facility, the organizers, sponsors, participants and persons transporting the girl/boy to and from activities for any claim arising out of injury to the except and in the amount covered by accident and/or liability insurance held by the local league. I also grant permission to managing personnel or other league representatives to authorize medical care from any licensed physician, hospital, or medical clinic, if the child becomes injured while participating in league activities away from parents/guardians. I also agree that my child's likeness may appear in any of the promotional materials, rule book covers, etc. in conjunction with the GKTA / USTA Summer Junior Team Tennis program.
Parent/Guardian Name (Please Print)*
Relationship to Candidate*
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Please provide names & phone numbers of persons coaches can call in case of emergency, cancelled practice, etc.
Name*
Phone*
Cell #*
Name*
Phone*
Cell #*
I wish to receive e-mail from GKTA Junior Team Tennis about Junior Tennis information (i.e. Tournaments and Special Events)*

YESNO
Does child have any medical issues of which the GKTA should be aware, such as diabetes, asthma, food allergies, heart murmur, etc.? Please specify details and emergency remedies.*
Level Requested - Select One
Coach/Tennis Pro will evaluate
Level Played During Previous 2025 GKTA Summer League
Please select the level that the student played during the Summer League. If the player was on multiple age division teams - SELECT the lowest age division that they played on. If they did not play Summer League, select N/A.
Level Played During Previous 2024 GKTA Middle School League
Please select the level that the student played during the Middle School League season. If they did not play in the 2023 Middel School League, please select N/A.
Describe Player Experience:
Student-Athlete & Parent/Legal Guardian Concussion Statement

Must be signed and completed prior to participation in practice or play.
After reading the information sheet, I am aware of the following information:
Parent/Legal Guardian Name:*
Student-Athlete Name:*
A concussion is a brain injury which should be reported to my parents, my coach(es) or a medical professional if one is available.
Parent/Legal Guardian Initials:*

Clear
Student-Athlete Initials:*

Clear
A concussion cannot be "seen". Some symptoms might be present right away. Other symptoms can show up hours or days after an injury.
Parent/Legal Guardian Initials:*

Clear
Student-Athlete Initials:*

Clear
I will tell my parents, my coach and/or medical professional about my injuries and illnesses.
Student-Athlete Initials:*

Clear
I will not return to play in a game or practice if a hit to my head or body causes any concussion-related symptoms.
Student-Athlete Initials:*

Clear
I will/my child will need written permission from a health care provider* to return to play or practice after a concussion.

*Health care provider means a Tennessee licensed medical doctor, osteopathic physician or a clinical neuropsychologist with concussion training.
Parent/Legal Guardian Initials:*

Clear
Student-Athlete Initials:*

Clear
Most concussions take days or weeks to get better. A more serious concussion can last for months or longer.
Parent/Legal Guardian Initials:*

Clear
Student-Athlete Initials:*

Clear
After a bump, blow or jolt to the head or body an athlete should receive immediate medical attention if there are any danger signs such as loss of consciousness, repeated vomiting or a headache that gets worse.
Parent/Legal Guardian Initials:*

Clear
Student-Athlete Initials:*

Clear
After a concussion, the brain needs time to heal. I understand that I am/my child is much more likely to have another concussion or more serious brain injury if return to play or practice occurs before the concussion symptoms go away.
Parent/Legal Guardian Initials:*

Clear
Student-Athlete Initials:*

Clear
Sometimes repeat concussion can cause serious and long-lasting problems and even death.
Parent/Legal Guardian Initials:*

Clear
Student-Athlete Initials:*

Clear
I have read the concussion symptoms on the Concussion Information Sheet.
Signature of Student-Athlete:*

Clear
Date*

MonthDayYear
Date
Athlete/Parent/Guardian Sudden Cardiac Arrest Symptoms and Warning Signs Information Sheet and Acknowledgement of Receipt and Review Form
What is sudden cardiac arrest?

Sudden cardiac arrest (SCA) is when the heart stops beating, suddenly and unexpectedly. When this happens, blood stops flowing to the brain and other vital organs. SCA doesn't just happen to adults; it takes the lives of students, too. However, the causes of sudden cardiac arrest in students and adults can be different. A youth athlete's SCA will likely result from an inherited condition, while an adult's SCA may be caused by either inherited or lifestyle issues. SCA is NOT a heart attack. A heart attack may cause SCA, but they are not the same. A heart attack is caused by a blockage that stops the flow of blood to the heart. SCA is a malfunction in the heart's electrical system, causing the heart to suddenly stop beating.
How common is sudden cardiac arrest in the United States?

SCA is the #1 cause of death for adults in this country. There are about 300,000 cardiac arrests outside the hospitals each year. About 2,000 patients under 25 die of SCA each year. It is the #1 cause of death for student athletes.
Are there warning signs?

Although SCA happens unexpectedly, some people may have signs or symptoms, such as: * fainting or seizures during exercise * unexplained shortness of breath * dizziness * extreme fatigue * chest pains * racing heart These symptoms can be unclear in athletes, since people often confuse these warning signs with physical exhaustion. SCA can be prevented, if the underlying causes can be diagnosed and treated.
What are the risks of practicing or playing after experiencing these symptoms?

There are risks associated with continuing to practice or play after experiencing these symptoms. When the heart stops, so does the blood that flows to the brain and other vital organs. Death or permanent brain damage can occur in just a few minutes. Most people who experience SCA die from it.
Public Chapter 325 - the Sudden Cardiac Arrest Prevention Act:

The act is intended to keep youth athletes safe while practicing or playing. The requirements of the act are: * All youth athletes and their parents or guardians must read and sign this form. It must be returned to the school before participation in any athletic activity. A new form must be signed and returned each school year. * The immediate removal of any youth athlete who passes out or faints while participating in an athletic activity, or who exhibits any of the following symptoms: (1) Unexplained shortness of breath (2) Chest pains (3) Dizziness (4) Racing heart rate (5) Extreme fatigue * Establish as policy that a youth athlete who has been removed from play shall not return to practice or competition during which the youth athlete experienced symptoms consistent with sudden cardiac arrest. * Before returning to practice or play in an athletic activity, the athlete must be evaluated by a Tennessee licensed medical doctor or an osteopathic physician. Clearance to full or graduated return to practice or play must be in writing.
I have reviewed and understand the symptoms and warning signs of SCA.
Print Student-Athlete's Name*
Signature of Student-Athlete*

Clear
Date*

MonthDayYear
Date
Print Parent/Guardian's Name*
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Should be Empty:

2025 GKTA Middle School League Player Information and Parental Consent Forms

A concussion is a brain injury which should be reported to my parents, my coach(es) or a medical professional if one is available.

A concussion cannot be "seen". Some symptoms might be present right away. Other symptoms can show up hours or days after an injury.

I will tell my parents, my coach and/or medical professional about my injuries and illnesses.

I will not return to play in a game or practice if a hit to my head or body causes any concussion-related symptoms.

I will/my child will need written permission from a health care provider* to return to play or practice after a concussion.

Most concussions take days or weeks to get better. A more serious concussion can last for months or longer.

After a bump, blow or jolt to the head or body an athlete should receive immediate medical attention if there are any danger signs such as loss of consciousness, repeated vomiting or a headache that gets worse.

After a concussion, the brain needs time to heal. I understand that I am/my child is much more likely to have another concussion or more serious brain injury if return to play or practice occurs before the concussion symptoms go away.

Sometimes repeat concussion can cause serious and long-lasting problems and even death.

I have read the concussion symptoms on the Concussion Information Sheet.

What is sudden cardiac arrest?

How common is sudden cardiac arrest in the United States?

Are there warning signs?

What are the risks of practicing or playing after experiencing these symptoms?

Public Chapter 325 - the Sudden Cardiac Arrest Prevention Act:

I have reviewed and understand the symptoms and warning signs of SCA.