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KE Concussion Code of Conduct

ATHLETES & PARENTS/GUARDIANS

I will help prevent concussions by:

  • Developing my skills and strengths so that I can participate to the best of my ability.
  • Respecting the rules of my sport or activity.
  • My commitment to fair play and respect for all (respecting all athletes, coaches, and administrative staff).

I will care for my health and safety by taking concussions seriously. I understand that:

  • A concussion is a brain injury that can have both short- and long-term effects.
  • A concussion may be caused by a blow to the head/neck/face or a blow to the body that whips the head back and forth.
  • I don’t need to lose consciousness to have a concussion.
  • I understand that continuing to train with a possible concussion may increase my risk of more severe, longer lasting symptoms, and increases my risk of other injuries.

I will not hide concussion symptoms. I will speak up for myself and others

  • If I believe I have ANY symptoms of a concussion, I must immediately stop participating in practice or competition and let my coaches know. 
  • I have a commitment to my teammates’ health and will let my coaches know if I am concerned a teammate may have sustained a concussion. 
  • I understand that if I have a concussion, I will be removed from sport and will not be able to return to practice/competition until I have been medically cleared to do so. 

I will take the time I need to recover because it is important to my health

  • I understand that if I have a concussion, I will be removed from sport and will not be able to return until I have been assessed by a medical professional.
  • I understand I will have to follow a Return-To-Sport Protocol following a concussion.
  • I understand I must be cleared by a medical professional to return to contact at training.
  • I will respect the decisions made by my coaches, parents and health-care professionals regarding my health and returning to sport safely. 

By signing here, I acknowledge that I have fully reviewed and commit to this Concussion Code of Conduct.  

Today's Date: October 24, 2021

First Athlete's Name

First Name*

Middle Name

Last Name*
First Athlete's Date of Birth*
I certify that I am 18 years of age or older
First Athlete's Signature*
Second Athlete's Name

First Name*

Middle Name

Last Name*
Second Athlete's Date of Birth*
Third Athlete's Name

First Name*

Middle Name

Last Name*
Third Athlete's Date of Birth*
Fourth Athlete's Name

First Name*

Middle Name

Last Name*
Fourth Athlete's Date of Birth*
Fifth Athlete's Name

First Name*

Middle Name

Last Name*
Fifth Athlete's Date of Birth*
Sixth Athlete's Name

First Name*

Middle Name

Last Name*
Sixth Athlete's Date of Birth*
Seventh Athlete's Name

First Name*

Middle Name

Last Name*
Seventh Athlete's Date of Birth*
Eighth Athlete's Name

First Name*

Middle Name

Last Name*
Eighth Athlete's Date of Birth*
Ninth Athlete's Name

First Name*

Middle Name

Last Name*
Ninth Athlete's Date of Birth*
Tenth Athlete's Name

First Name*

Middle Name

Last Name*
Tenth Athlete's Date of Birth*
Parent or Guardian's Email Address

Email*

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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
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