Sports Team Concussion Consent Form
Participant Name
Date of Birth
Team Name
Coach Name
Concussion Information
Consent
I have read and understand the information provided about concussions.
I agree to immediately report any signs, symptoms, or suspicion of concussion.
I acknowledge that a concussed athlete cannot return to play without medical clearance.
I understand the risks of not reporting or playing while symptomatic.
I have discussed concussion safety with my child (if participant is under 18).
Parent/Guardian Name (if under 18)
Participant Signature
Date
Parent/Guardian Signature (if under 18)
Date