Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Parks & Recreation- CDC HEADSUP Concussion Form

  1. ACKNOWLEDGEMENT THAT PARTICPANT HAS READ CDC HEADS UP DOCUMENT*

    This form is used as acknowledgement that the child/athlete and parent/guardian have discussed the risks of concussion and other serious brain injuries, as well as ways to protect against such injuries, as described in the CDC HEADS UP information sheet.

  2. I learned about concussion from the CDC HEADS UP fact sheet and talked with my parent or coach about what to do if I have a concussion or other serious brain injury. By typing your first and last name above, you are agreeing and acknowledging that your digital signature is valid and binding upon you to the same force and effect as a handwritten signature.

  3. I have read the CDC HEADS UP 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. By typing your first and last name above, you are agreeing and acknowledging that your digital signature is valid and binding upon you to the same force and effect as a handwritten signature.

  4. Leave This Blank:

  5. This field is not part of the form submission.