DISCLOSURES - CARDIAC

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 warning signs and talked with my parent or coach about what to do if I have any symptoms.

Yes

Athlete's Name:

Date:

Athlete's Signature:

I have read this fact sheet on sudden cardiac arrest prevention with my student athlete and talked about what to do if they experience any warning signs, and what to do should we witness a cardiac arrest.

Yes

Parent or Legal Guardian's Name:

Parent or Legal Guardian's Signature:

Date:

TM

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