DISCLOSURES - CONCUSSION

We need some information about you, the Parent/Guardian. Even if you are registering a child, we need your information first. You have the option to add a second Parent/Guardian. You will enter your child’s information on the next screen.

Parent Details

Player Details

Disclosures

Programs

I learned about concussion and talked with my parent or coach about what to do if I have a concussion or other serious brain injury

Yes

Athlete's Name:

Date:

Athlete's Signature:

I have read this fact sheet for parents on concussion with my child or teen, and talked about what to do if they have a concussion or other serious brain injury.

Yes

Parent or Legal Guardian's Name:

Parent or Legal Guardian's Signature:

Date:

RESOURCES FOR:

TM

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