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NOTE:

For official copies of board policies and procedures please contact the superintendent's office at (253) 583-5190 or email supt@cloverpark.k12.wa.us

Form 3422-F1

Student Sports-
Concussion, Head Injury and Sudden Cardiac Arrest:

Student/Parent Awareness Form

Clover Park School District (CPSD) believes participation in athletics improves physical fitness, coordination and self-discipline, and gives students valuable opportunities to learn important social and life skills.

As a parent/guardian or student you play a vital role in protecting participants and helping them get the best from sport.

Player and parental education in this area is crucial which is the reason for the Concussion Management and Sudden Cardiac Arrest Awareness pamphlet you received (3422-F3). Refer to it regularly

This form must be signed annually by the parent/guardian and student prior to participation in CPSD athletics. If you have questions regarding any of the information provided in the pamphlet, please contact the athletic director at your school.

I HAVE RECEIVED, READ AND UNDERSTAND THE INFORMATION PRESENTED IN THE CONCUSSION RECOGNITION AND SUDDEN CARDIAC ARREST AWARENESS PAMPHLETS.


Student Name (Printed)

Student Name (Signed)

Date

Parent Name (Printed)

Parent Name (Signed)

Date