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Parent Concussion Agreement

Related to Concussion Law 2011- Wisconsin Act 172

As a parent and as an Athlete it is important to recognize the signs, symptoms, and behaviors of concussions. By signing this form, you are stating you understand the importance of recognizing and responding to the signs, symptoms, and behaviors of a concussion or head injury. This form must be completed for every sports season and every youth athletic organization the athlete is involved with.

I have read the Parent Concussion and Head Injury Information and undestand what a concusison is and how it may be caused. I also understand the common signs, symptoms, and behaviors. I agree that my child must be removed from practice/play if a concussion is suspected. 

I understand that it is my responsibility to seek medical treatment if a suspected concussion is reported to me. 

I understand that my child cannot return to practice/play until providing written clearance from an appropriate health care provider to his/her coach. 

I understand the possible consequences of my child returning to practice/play too soon. 

Questions & Contact Information

Include Address, City, State, Zip Code and County​
Check the sport that applies for your athlete. (Please check only one, as this document must be completed for each sport that your student is involved in.) My athlete participates in: ​
Name of Current Team​
Have you ever had a concussion? ​
If yes, how many? ​
Have you ever had concussion symptoms? ‚Äč​
If yes, did you report them? ​

Emergency Contact Information: 

Recreation Calendar

    • MonMar19 Advanced Learning Information Session 6:00 PMSHS Library
    • WedApr04 SHS Linkage 7:15 PMSHS Conference Room #116
    • ThuApr05 Shorewood Library, Senior Center, Connects, and Historical Society Linkage 1:00 PMSHS Conference Room #116
    • ThuApr05 SIS Linkage 6:45 PMSHS Conference Room #116
    • TueApr10 Student Linkage 12:00 PMSHS Auditorium
    • TueApr10 School Board Meeting 7:00 PM
    • ThuApr12 Special Education Info Session 6:00 PMSHS Library
    • WedApr18 BID/Realtors Linkage 9:00 AMCommittee Room at Village Hall
    • FriApr20 Atwater Linkage 8:20 AMRoom 6 Atwater Elementary
    • FriApr20 SIS Activity Night 7:00 PM to 9:00 PMSIS Commons

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