Concussion Parent Waiver

Player Name(Required)

First Name Last Name

Parent Name(Required)

First Name Last Name

Team - Coach Last Name(Required)

Type of Event(Required)

Date of Injury(Required)

List as 00-00-000

Tournament Name(Required)

If the injury occurred during practice, please write "none"

Consent

I understand that my signature authorizes Hunterdon Hoosiers Inc. to allow my child to return to play as I do not believe my child's head injury is displaying symptoms of a concussion.

Signature Name(Required)

First Last

Signature Email(Required)