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The safety of our Athletes is a priority and practicing or playing with concussion symptoms can

prolong a recovery. Concussions can be serious, and any additional concussions can be very

serious, and subsequent or continual concussions may cause brain damage.


An Athlete should be removed from Practice(s) and Competition(s) until they are

symptom-free and completes the Return to Play Protocol.


The Concussion Protocol has been made available for me to review.


I have read, acknowledge, understand, and agree to the Concussion Protocol for my player.


Athlete’s Signature (Required): _________________________________


Parent/Legal Guardian’s Name: _________________________________


Parent/Guardian’s Signature: _________________________________

*Required if student is less than 18 years of age.


Date: ________________

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