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Student-athlete & Parent/Legal Guardian Concussion Statement Must be signed and returned to school or community youth athletic activity prior to participation in practice or play. Student-Athlete Name: Grade:
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Document Date: 2014-01-31 09:57:30
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File Size: 67,64 KB
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MedicalCondition
loss of consciousness /
brain injury /
vomiting /
serious brain injury /
injury /
injuries /
headache /
/
Person
Initials Parent /
/
Position
coach /
Student/Athlete /
osteopathic physician /
Student-Athlete /
athlete /
/
ProvinceOrState
Tennessee /
/
SocialTag
Second-impact syndrome
Neurotrauma
Concussion
Concussion grading systems
Student-athlete & Parent/Legal Guardian Concussion Statement Must be signed and returned to school or community youth athletic activity prior to participation in practice or play. Student-Athlete Name: Grade: