EXTRA-CURRICULAR

Student Acknowledgment *

I acknowledge that I have reviewed and will use best practices for concussion prevention and follow proper concussion reporting and other protocols.

Student Name *

First Name

Last Name

Parent/Guardian Acknowledgment

I acknowledge that I have reviewed with my student and we will use best practices for concussion prevention and follow proper concussion reporting and other protocols.

Parent/Guardian Name *

First Name

Last Name

Date of Acknowledgment

MM

DD

YYYY