Waiver's - Club Participation and Concussion
Email address *
Name of Child this Waiver Covers *
Your answer
Do you allow your child to attend and participate in all Merton Area Running Club practices, meets and activities? *
Do you agree to release Merton Area Running Club and all of it's agents and or members from all liability for any injury which may occur to you or your child participating in the activities of the Merton Area Running Club, or while traveling to or from such activities? *
Required
Do you agree to release the Merton Area Running Club from all liability for any medical conditions (pre-existing or not) arising after participation in Merton Area Running Club activities? *
Required
Concussion Protocol: Related to Concussion Law 2011 - Wisconsin Act 172 - Do you understand the importance of recognizing and responding to the signs, symptoms, and behaviors of a concussion or head injury. *
Parent, by providing your name you agree that you have read the Parent Concussion and Head Injury Information and understand what a concussion is and how it may be caused. *
Your answer
Parent, please provide today's date to accompany your name as recognition of your understanding of concussions. *
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Parent above, do you understand the common signs, symptoms, and behaviors of a concussion? *
Parent above, do you agree that your child must be removed from practice/play/activity if a concussion is suspected? *
Parent above, do you understand that it is your responsibility to seek medical treatment if a suspected concussion is reported to you? *
Parent above, do you understand, that your child cannot return to practice/play until providing written clearance from an appropriate health care provider to their coach? *
Parent above, do you understand the possible consequences of your child returning to practice/play too soon? *
Athlete, by providing your name, you agree that you have read the Athlete Concussion and Head Injury Information and understand what a concussion is and how it may be caused. *
Your answer
Athlete above, do you understand the importance of reporting a suspected concussion to your coaches and your parents/guardian? *
Athlete above, do you understand you must be removed from practice/play if a concussion is suspected? *
Athlete above, do you understand that you must provide written clearance from an appropriate health care provider to your coach before returning to practice/play? *
Athlete above, do you understand the possible consequences of returning to practice/play too soon and that your brain needs time to heal?
Athlete, please provide today's date to accompany your name as recognition of your understanding of concussions. *
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What activities does athlete participates in? Check all that apply. *
Required
Athlete, how many concussions have you had? *
Athlete, have you ever experienced concussion symptoms? *
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