CONCUSSION AWARENESS EDUCATIONAL MATERIAL ACKNOWLEDGEMENT FORM
By my name and signature below, I acknowledge in accordance with Public Acts 342 and 343 of 2012 that I have received and reviewed the Concussion Fact Sheet for Parents and/or the Concussion Fact Sheet for Students provided by Paw Paw Public Schools.
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Participant Last Name: *
Participant First Name: *
Participant's Electronic Signature: *
As the participant, please type your name to be submitted as an electronic signature.
Parent/Guardian Last Name: *
A student may sign on their own if they are 18+ years of age or otherwise eligible.
Parent/Guardian First Name: *
A student may sign on their own if they are 18+ years of age or otherwise eligible.
Parent/Legal Guardian's Electronic Signature: *
As parent/legal guardian, please type your name to be submitted as an electronic signature.
Today's Date: *
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This form was created inside of Paw Paw Public Schools.