Consent Form For use of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) I have read the attached information. I understand its contents. I have been given an opportunity to ask questions and all questions have been answered to my satisfaction. I agree to participate in the ImPACT Concussion Management Program. Printed Name of Athlete ___________________________________ Sport ____________________________________ __________________________________ __________________________ Signature of Athlete Date __________________________________ __________________________ Signature of Parent Date
Consent Form For use of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) I have read the attached information. I understand its contents. I have been given an opportunity to ask questions and all questions have been answered to my satisfaction. I agree to participate in the ImPACT Concussion Management Program. Printed Name of Athlete ___________________________________ Sport ____________________________________ __________________________________ __________________________ Signature of Athlete Date __________________________________ __________________________ Signature of Parent Date
IMPACT%20PermissionForm%20(1).docx