CONCUSSION AWARENESS EDUCATIONAL MATERIAL ACKNOWLEDGEMENT FORM By my name and signature below, I acknowledge in accordance with Public Acts 342 and 343 of 2012 that I have received and reviewed the Concussion Fact Sheet for Parents and/or the Concussion Fact Sheet for Students provided by A.M.A.A. (Sponsoring Organization) __________________________________ ________________________________________ Participant Name Printed Parent or Guardian Name Printed __________________________________ ________________________________________ Participant Name Signature Participant/Guardian Name Signature _____________ _________________ Date Date Return this signed form to the sponsoring organization that must kept on file for the duration of participation or age 18. Participants and parents please review and keep the educational materials available for future reference.
CONCUSSION AWARENESS EDUCATIONAL MATERIAL ACKNOWLEDGEMENT FORM By my name and signature below, I acknowledge in accordance with Public Acts 342 and 343 of 2012 that I have received and reviewed the Concussion Fact Sheet for Parents and/or the Concussion Fact Sheet for Students provided by A.M.A.A. (Sponsoring Organization) __________________________________ ________________________________________ Participant Name Printed Parent or Guardian Name Printed __________________________________ ________________________________________ Participant Name Signature Participant/Guardian Name Signature _____________ _________________ Date Date Return this signed form to the sponsoring organization that must kept on file for the duration of participation or age 18. Participants and parents please review and keep the educational materials available for future reference.
new_registration_form2__fall_2017_new_members.docx