Effective January 1, 2012, a new law ( Education Code Section 49475), requires the student and parent/legal guardian must sign this Concussion Head Injury Information Sheet before a Student may try-out, practice, or compete in any District-sponsored extracurricular athletic program, including interscholastic, intramural, or other sport or recreation programs (including cheer/dance teams and band), but excluding physical education courses for credit.
Coach or other removes student from activity and completes form and gives to student or parent. Included medical release must be obtained before student can return to play. Optional to use for other serious injuries.
User is a nonprofit organization, or a club or association (other than a public agency) organized to promote youth and school activities, which will not engage in fund raising activities not designed to benefit your or public school activities on School District property.
One Student Activity Waiver Form is required for EACH activity and signed by a parent and student. This form is used for extracurricular activities or clubs such as a language club, speech and debate, chess club. This form is available in other languages by calling Risk Management Office.
Use this universal form when reporting an incident or student injury. Reminder: this is confidential SCUSD information and cannot be released to parent or other party. Please call Risk Management if you have any questions at 643-9421.