The head is one of the most important parts of the body which should be safe and secure at all times. This is due to its
fragility wherein one hit can cause trauma to the brain and can affect the entire being of the victim. However, the
aforementioned fact must not forbid an individual to do activities that he wants to fulfill even if they involve extreme
actions. This is why there are still organizations who offer sports or programs that will engage people who are into
sports and physical fitness. But, these organizations must ensure that their participants are well informed of the
possibilities as they participate, especially in having concussions or traumatic brain injuries during or after the activity.
This is when a concussion acknowledgment form becomes useful, for both informing the participant and protecting the organization from medical and financial liabilities.
Concussion Acknowledgment Form Sample
What Is a Concussion Acknowledgment Form?
A concussion acknowledgment form is a document which must be filled out and signed by a participant of activities
which can result in him having a head injury or concussion after the activity or event. This form is often provided by
organizers of sports activities and educational institutions who will be accepting students to join rigorous and risky
Athlete Concussion Acknowledgment Form
Why Is a Concussion Acknowledgment Form Important?
Concussion acknowledgment forms are important because it is the tool that documents the agreement of the
participant and his legal guardian to be engaged in the activity regardless of their knowledge that the participant
may acquire an injury. The form can also include the requirement of the organization to have the signers waive their
rights in holding the organization liable for any unlikely events that will happen in the duration of the activity. This
means that not only details about the risks and possibilities will be stated in the concussion acknowledgment form, but
also the agreement and approval of the signers in not being able to sue and ask for any type of aid including financial aid
from the organization if the participant will be injured.
Concussion Acknowledgment and Signature Form
When Should Concussion Acknowledgment Forms Be Used Provided?
Sports organizations and extreme activities organizers must provide concussion acknowledgment forms to their
participants before the activity will be conducted. This means that before any practice or competition, the participant
should be informed about the risks and should be able to fill out and sign the acknowledgment form along with other
documents that will disclose his medical information and his data.
Concussion Acknowledgment Form in DOC
How to Create a Standard Concussion Acknowledgment Form for Athletes
Athletes are the most common group or category of individuals who are prone to having concussions since they are
engaged in sports practices or various types and in actions requiring them to use their full physical potential. This is the
reason why concussion acknowledgment forms are often created for them in order to inform them about the risks and
injuries. To create the form, the steps below must be followed by the individual who is assigned to make and prepare
the standard concussion acknowledgment forms for a group of athletes:
Step 1: Prepare the document sheet to use.
The document sheet to be used should be readily prepared from the margin sizes that the organization prefers for the acknowledgment form, the typeface choice, and its sizes, as well as the layout and the sectioning of the contents.
Step 2: Add a header.
Most sports organizations and institutions have their own header which is will have their branding preferences. The
header must be placed at the topmost portion of each sheet to use for the form. On the other hand, if the organization
does not have a header yet, then making one is an option to take. In the header, the name of the organization is the first
item to place at the topmost center portion of the form. Beside the name should be the logo of the organization, either
in the left or right side, depending on the organization’s preferences. Below the name of the organization must be the
office address and the contact information of the organization along with their email or electronic mailing information.
Step 3: Name the form.
The title of the form must be indicated below the header which should state “Athlete Concussion Acknowledgment Form” or “Acknowledgment for Concussion and Risks for Athletes”.
Step 4: Indicate an introduction and the set of instructions to be followed.
The introduction must contain relevant information about the sport and the injuries which are possible to be obtained by
the participating athlete, as well as the symptoms to look out for when an accident occurs. After the introduction, the
instructions and guidelines which must be followed by the athlete and their legal guardian in filling out the
acknowledgment form are included in this section as well.
Step 5: Make an athlete information section.
This section of the acknowledgment form must be able to collect the general information of the athlete such as his name, his identification number, his phone number, and the names of his parents or his legal guardian who will be finalizing decisions for him if he is still a minor individual. Other pieces of information to gather in this section can be the residential address of the athlete and the school or institution that he is representing. In making this section, blanks, and underlines can be used for each data to be collected. The blanks must also be accompanied by labels of what information will be stated in it to guide the user of the form.
Step 6: Create a table after the information section.
This will be the second section of the form to be filled out by the user or the athlete and his legal guardian. The table must be composed of three columns and a number of rows. Each column must be labeled appropriately wherein the first column will be for initials of the athlete or his signature. The second column is to be intended for the understanding and the agreements of the user, while the last column is for the signature of the legal guardian of the athlete.
Step 7: Incorporate a signature block.
Each of the initials to be placed on the table is only for indicating that the users have read each item or each agreement required to be understood for their participation. While the signature block is for indicating their approval and their choice to continue taking part in the sports or the competition regardless of the risks and the possibilities of the athlete to obtain any type of concussion. In the signature block, there must also be an area for stating when the users have signed the acknowledgment.
Step 8: Save the form.
The form must be saved in a format which allows future edits to be made. In addition, the data fields in the form must be kept blank at all times after it is used.
Concussion Information and Acknowledgement Form
There are three formats to consider when making concussion acknowledgment forms: “.DOC”, “.PDF”, “.XLS”. The
“.DOC” format is the most common and the basic format which is used by document-preparers. This format is to be
opened using texts or word-processor such as Microsoft’s Word application and OpenOffice Document. When choosing
to use the “.DOC” format, the document-preparer will be able to obtain some benefits such as being able to make
updates or changes in the acknowledgment form which was already made. Another is that the “.DOC” format is easy to
use which benefits both the document-preparer and the target or the end-user of the form.
A “.XLS” format is intended to be used along with a spreadsheet software application. This format will allow the
document-preparer to have a layout which already contains rows and columns that he can make into a table. With the
columns and rows, the document-prepare will have more organized sectioning for the layout or the arrangements of
the contents of the acknowledgment form.
If the organization will be posting or be uploading their concussion acknowledgment forms to their website and social
media platforms, then they should consider using a document in “.PDF” format. The term “.PDF” refers to “portable
document file” format. This type of format compresses the document, either it is in “.DOC” or in “.XLS” formats. This
means that a “.PDF” format can only be made after the two other formats are created as its own base document. One advantage of converting a document to “.PDF” is that it will compress, protect, and make the file size smaller compared
to the other two formats.
Concussion Protocol Acknowledgment Form
Regardless of whether the concussion acknowledgment form will be made in “.DOC”, “.XLS”, or in “.PDF”, the form itself must be able to meet its objective or its purpose of why the form was made which is to inform and document the
approval of the parties involved in an activity. In addition, the users of the forms must also be guided on how they can
fulfill their roles in completing the form as well as keep in mind of their obligations before they will be affixing their
signatures on the form.
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