Get Pre-participation Head Injury/concussion Reporting Form For ...

This guide provides essential instructions on how to complete the Pre-Participation Head Injury/Concussion Reporting Form for extracurricular activities. It aims to assist users in accurately filling out the form to ensure safety and compliance for student athletes.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the Pre-Participation Head Injury/Concussion Reporting Form and open it in the editor.
2. Fill in the student name field with the full name of the student athlete.
3. Indicate the sex of the student by selecting the appropriate option.
4. Enter the school name where the student is enrolled.
5. List the sport(s) that the student will be participating in during extracurricular activities.
6. Provide the date of birth (DOB) of the student in the specified format.
7. Indicate the grade level of the student.
8. Fill in the home address of the student, making sure to include the full address.
9. Provide the home telephone number of a parent or guardian.
10. Answer the question regarding whether the student has ever experienced a traumatic head injury by selecting ‘Yes’ or ‘No’. If ‘Yes’, please specify the dates.
11. Respond to the question about whether the student has ever received medical attention for a head injury. If ‘Yes’, include the dates and describe the circumstances briefly.
12. Indicate if the student was diagnosed with a concussion by selecting ‘Yes’ or ‘No’. If ‘Yes’, state the date of diagnosis.
13. Detail the duration of any symptoms experienced, such as headaches or difficulties concentrating, from the most recent concussion.
14. Complete the parent/guardian section by printing their name, then having them sign and date the form.
15. The student athlete must also sign and date the form.
16. Finally, save changes, download, print, or share the form as necessary.

Complete the Pre-Participation Head Injury/Concussion Reporting Form online today to ensure the safety of student athletes.