Sponsored By:   Jersey Mikes Indian Trail
Union County NC
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Adobe PDF file Concussion Form *

Adobe PDF file 2020-2021 Physical Form *- Please use this form if your physical was PRIOR TO 3/1/2019. *Updated for the 2020-2021 School Year

Birth Certificate- Please provide Coach/Team Representative with a valid copy of student athletes Birth Certificate.

Microsoft Word file Covid-19 Initial Screen- This document is REQUIRED PRIOR TO BEGINNING workouts on July 6,2020. This form is an initial screen. Temperatures and screening will occur each day that athlete participates in workouts. IF an athlete has or shows signs/symptoms of COVID-19, the athlete will be asked/expected to go home & not return UNTIL he/she has received MEDICAL CLEARANCE FROM A LICENSED MEDICAL PROVIDER.

Adobe PDF file ImPact Concussion Test *- MUST BE TAKEN BY STUDENT ATHLETE ONLY. Please allow approximately 30-45 minutes to take test. Print Passport ID at completion of test. This test is VERY IMPORTANT in establishing neurological baseline when treating a concussion. Test is only to be taken one time. If test is taken PRIOR TO AGE 12, test must be retaken at age 12.

Adobe PDF file Insurance Form *- *Must be notarized

Adobe PDF file Medical Release Form *- *Must be notarized

Adobe PDF file SVABC Athlete - Parent/Guardian Code of Conduct *

Note some or all of the preceding documents can be downloaded and displayed and/or printed in Adobe's Acrobat format.  If you do not have Adobe's free Acrobat Reader software, download it now.