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Temple Concussion Agreement Form

CONCUSSION MANAGEMENT INFORMATION AND POLICY ACKNOWLEDGEMENT

My signature below confirms that I have read and understand the Temple Academy Concussion Management Policy printed in the Temple Academy Athletic Handbook.

The Temple Academy Athletic Handbook is available on the Temple Academy Athletic Website. https://templeacademyhs.rschoolteams.com/ under the link “Forms/Resources”. If you do not have access to “online” information, a written copy of the “Athletic Handbook” or any required form may be obtained by requesting a copy from Athletic Director.

I am also aware that any questions that I have regarding the rules, regulations, or concussion policy may be directed toward Temple Academy Athletic Director Phil Hubbard at phil.hubbard@templeacademy.org or 873-5325.

Parent/Guardian's Electronic Signature: *

(First Name Last Name)

Student/Athlete's Electronic Signature: *

(First Name Last Name)