CONCUSSION/HEAD INJURY AND SUDDEN CARDIAC ARREST ACKNOWLEDGEMENT
The purpose of the Acknowledgement form is to confirm that you have read and understand the information provided to you by the WHSBLA related to potential Concussion/Head Injury and Sudden Cardiac Arrest (SCA) occurring during participation in athletic programs.
I, ____________________________as a student at ,____________________________,
And I __________________________________as the parent / legal guardian of
_______________________________have read and understand the information material
provided to us related to Concussion / Head Injury and Sudden Cardiac Arrest (SCA)
during participation in athletic programs and understand its contents and warnings.
Signature of Student / Athlete Date
Signature of Parent / Legal Guardian Date
__________We were provided a copy of the Information Sheet for Parents/Legal Guardians and Athletes: Concussion/Head Injury and Sudden Cardiac Arrest (SCA).
Reference: SB 5083
HB 1824 (RCW 28A.600 & RCS 4.24.660)