If you are completing this Concussion Notification Form for or on behalf of a player with a suspected concussion, by clicking submit you confirm you have consent from that player to provide their personal information.
By clicking submit, you agree New Zealand Rugby Union Incorporated (“NZR”) collects personal information from you, including:
NZR collects the personal information in this Concussion Notification Form in order to provide a player with a suspected concussion advice and assistance related to managing concussion, getting medical treatment, preventing further injury, ensuring player safety, and a process for return to play. In addition, NZR will share this information with the player who has a suspected concussion, their school or club and the affiliated Provincial Union. NZR and the relevant Provincial Union may also share this information with other sporting organisations or relevant health professionals for the above prurposes. NZR may retain personal information about you electronically and in hard copy records. NZR will retain personal information only for as long as it has a lawful purpose to use it. NZR will take all reasonable steps to protect the personal information it holds from misuse, interference and loss and from unauthorised access, modification and disclosure.
Providing some information is optional. If you choose not to enter any of the personal information, NZR will not be able to provide advice and assistance in relation to NZR’s concussion management pathway.
The player with a suspected concussion has the right to ask for a copy of any personal information we hold about them, and to ask for it to be corrected if they think it is wrong. If the player with a suspected concussion would like to ask for a copy of their personal information, or to have it corrected, please contact us at concussion@nzrugby.co.nz.