Communicable Disease Release Of Liability And Assumption Of Risk Agreement(Required) I agree
In consideration of being allowed to participate in any way in any Belleview United related events and activities I, the undersigned participant, parent, or legal guardian, acknowledge, appreciate, and agree that:
HEADS UP Concussion Waiver
This sheet has information to help protect your children or teens from
concussion or other serious brain injury. Use this information at your
children or teens’ games and practices to learn how to spot a concussion and
what to do if a concussion occurs.
A concussion is a type of traumatic brain injury—or TBI—caused by a bump,
blow, or jolt to the head or by a hit to the body that causes the head and
brain to move quickly back and forth. This fast movement can cause the brain
to bounce around or twist in the skull, creating chemical changes in the
brain and sometimes stretching and damaging the brain cells.
Sports are a great way for children and teens to stay healthy and can help
them do well in school. To help lower your children or teens’ chances of
getting a concussion or other serious brain injury, you should:
● Help create a culture of safety for the team.
● Work with their Coach to teach ways to lower the chances of getting
a concussion.
● Talk with your children or teens about concussion and ask if they
have concerns about reporting a concussion. Talk with them about their
concerns; emphasize the importance of reporting concussions and taking time
to recover from one.
● Ensure that they follow their Coach’s rules for safety and the rules
of the sport.
● Tell your children or teens that you expect them to practice good
sportsmanship at all times.
● When appropriate for the sport or activity, teach your children or
teens that they must wear a helmet to lower the chances of the most serious
types of brain or head injury. However, there is no “concussion-proof”
helmet. So, even with a helmet, it is important for children and teens to
avoid hits to the head.
Children and teens who show or report one or more of the signs and symptoms
listed below—or simply say they just “don’t feel right” after a bump, blow,
or jolt to the head or body—may have a concussion or other serious brain
injury.
Signs Observed by Parents or Coaches
● Appears dazed or stunned.
● Forgets an instruction, is confused about an assignment or position,
or is unsure of the game, score, or opponent.
● Moves clumsily.
● Answer questions slowly.
● Loses consciousness (even briefly).
● Shows mood, behavior, or personality changes.
● Can’t recall events prior to or after a hit or fall.
Symptoms Reported by Children and Teens
● Headache or “pressure” in head.
● Nausea or vomiting.
● Balance problems or dizziness, or double or blurry vision.
● Bothered by light or noise.
● Feeling sluggish, hazy, foggy, or groggy.
● Confusion, or concentration or memory problems.
● Just not “feeling right,” or “feeling down.”
Talk with your children and teens about concussion. Tell
them to report their concussion symptoms to you and their Coach right away.
Some children and teens think concussions aren’t serious or worry that if
they report a concussion they will lose their position on the team or look
weak. Be sure to remind them that it’s better to miss one game than the
whole season.
Concussions affect each child and teen differently. While
most children and teens with a concussion feel better within a couple of
weeks, some will have symptoms for months or longer. Talk with your children
or teens’ health care providers if their concussion symptoms do not go away
or if they get worse after they return to their regular activities.
In rare cases, a dangerous collection of blood (hematoma) may form on the
brain after a bump, blow, or jolt to the head or body and can squeeze the
brain against the skull. Call 9-1-1 or take your child or teen to the
emergency department right away if, after a bump, blow, or jolt to the head
or body, he or she has one or more of these danger signs:
● One pupil is larger than the other.
● Drowsiness or inability to wake up.
● A headache that gets worse and does not go away.
● Slurred speech, weakness, numbness, or decreased coordination.
● Repeated vomiting or nausea, convulsions or seizures (shaking or
twitching).
● Unusual behavior, increased confusion, restlessness, or agitation.
● Loss of consciousness (passed out/knocked out). Even a brief loss of
consciousness should be taken seriously.
Children and teens who continue to play while having concussion symptoms or
who return to play too soon—while the brain is still healing— have a greater
chance of getting another concussion. A repeat concussion that occurs while
the brain is still healing from the first injury can be very serious and can
affect a child or teen for a lifetime. It can even be fatal.
As a parent, if you think your child or teen may have a concussion, you
should:
Remove your child or teen from play.
Keep your child or teen out of play the day of the injury. Your child or
teen should be seen by a health care provider and only return to play
with permission from a health care provider who is experienced in
evaluating for concussion.
Ask your child’s or teen’s health care provider for written instructions
on helping your child or teen return to school. You can give the
instructions to your child’s or teen’s school nurse and teacher(s) and
return-to-play instructions to the coach and/or athletic trainer.
Do not try to judge the severity of the injury yourself. Only a health care
provider should assess a child or teen for a possible concussion. Concussion
signs and symptoms often show up soon after the injury. But you may not know
how serious the concussion is at rst, and some symptoms may not show up for
hours or days. The brain needs time to heal after a concussion. A child’s or
teen’s return to school and sports should be a gradual process that is
carefully managed and monitored by a healthcare provider.
To learn more, go to
https://www.cdc.gov/HeadsUp/
Link
Parent/Athlete Information Sheet
Link
Fact
Sheet for Athletes 
