Socorro ISD Physical Packet Student Athlete Information Sheet (Clearly Print all information in Black or Blue Ink only.)
|
|
- Patrick Doyle
- 6 years ago
- Views:
Transcription
1 Socorro ISD Physical Packet Student Athlete Information Sheet (Clearly Print all information in Black or Blue Ink only.) School ID #: Grade: Graduation Date: Name: M ( ) F ( ) Date of Birth: Age: Home Address: Zip Code: Home Phone #: List Sport(s) or Activities involved in: Legal Guardians Name and Phone # Information: Father: Name: Place of Employment: Home Phone #: Cell #: Work #: Mother: Name: Place of Employment: Home Phone #: Cell #: Work #: Emergency Contact: Name: Relationship: Home Phone #: Cell #: Work #: Check any Medical Problems your child may have: Asthma Epilepsy Diabetes High Blood Pressure Sickle Cell Kidney Problems List ANY other problems not mentioned: Name of Doctor prescribing meds: Check any allergies your child may have: None Erythromycin Ampicillin Tetracycline Penicillin Sulfa Codeine Aspirin Foods Other Allergies: Consent Statement Authorizing Treatment I/ we give permission to duly authorized school personnel and medical doctors to render appropriate medical treatment for any injury sustained during a scheduled practice, game, or supervised school approved trip; should it be necessary to do so. Parent/ Legal guardian Signature: Date: revised March 2013
2 *Please Read Carefully* Socorro ISD Physical Packet Warning, Agreement to Follow Instructions, Release, Assumption of Risk, and Agreement to Hold Harmless Student / Parent: I / We are aware that playing or practicing to play / participate in any sport can be a dangerous activity involving MANY RISKS OF INJURY. I / We understand that the dangers and risks of playing or practicing to play / participate in the sports / activities include but are not limited to: death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the muscular skeletal system, and serious injury impairments to other aspects of the body, general health, and well-being. I understand that the dangers and risks of playing or practicing to play / participate in sport(s) may result not only in serious injuries, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities, and to generally enjoy life. Because of the dangers of participating in sport(s), I recognize the importance of following coaches instructions regarding playing techniques, training and other team rules, etc., and to agree to follow such instructions. I am aware that if my son/daughter is going to participate in one of the following sports: (Football, Basketball, Soccer, Wrestling, Baseball, Softball). They are participating in a violent contact sport involving even greater risk than other sports in Socorro ISD. In consideration of the Socorro Independent School District permitting me to try out for any Socorro ISD athletic team(s), to engage in all activities related to the team(s), including but not limited to, trying out, practicing, or playing/participating in that sport. I hereby assume all the risks associated with participation and agree to hold Socorro Independent School District, its employees, agents, representatives, coaches, licensed athletic trainers, and volunteers harmless from any and all liability, actions, causes of actions, debts, claims, or demands of any kind and nature whatsoever which may arise by or in connection with my participation in any activities related to the Socorro ISD sports team(s) indicated above. The terms hereof shall serve as a release and assumption of risk for my heirs, estate, executor, administrator, assignees, and for all members of my family. Student Signature: Date: Parent Signature: Date:
3
4
5 SOCORRO INDEPENDENT SCHOOL DISTRICT Department of Athletics PARENTAL INFORMATION AND CONSENT FORM WHAT IS A CONCUSSION? A concussion is an injury to the brain. It is caused by a bump, blow, or jolt to either the head or the body that causes the brain to move rapidly within the skull. The resulting injury to the brain changes how the brain functions in a normal manner. The signs and symptoms of a concussion can show up immediately after the injury or may not appear for hours or days after the injury. Concussions can have serious long-term health effects, and even a seemingly mild injury can be serious. A major concern with any concussion is returning to play too soon. Having a second concussion before healing can take place from the initial or previous concussion can lead to serious and potentially fatal health conditions. WHAT ARE THE SYMPTOMS? Signs and symptoms of a concussion are typically noticed right after the injury, but some might not be recognized until days after the injury. Common symptoms include: headache, dizziness, amnesia, fatigue, confusion, mood changes, depression, poor vision, sensitivity to light or noise, lethargy, poor attention or concentration, sleep disturbances and aggression. The individual may or may not have lost consciousness. WHAT SHOULD BE DONE IF A CONCUSSION IS SUSPECTED? 1. Immediately remove the student from practice or game 2. Seek medical attention right away 3. As per Texas State Law, do not allow the student to return to play until proper medical clearance and return to play guidelines have been followed. The permission for return to play will come from the appropriate health care professional. If you have any questions concerning concussions or the return to play policy, you may contact the athletic administrator at your school. WHAT SHOULD THE ATHLETE KNOW ABOUT PLAYING WITH A CONCUSSION? Teach athletes it s not smart to play with a concussion. Rest is the key after a concussion. Occasionally athletes, parents, school staff and/or league officials wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don t let your athlete convince you that they re just fine. WHAT ARE THE RISKS OF RETURNING TO ACTIVITY TOO SOON AFTER SUSTAINING A CONCUSSION? Prevent long-term problems. If an athlete has a concussion, their brain needs time to heal. Don t let them return to play the day of the injury and until a health care professional says they are symptom-free and it s OK to return to play. A repeat concussion that occurs before the brain recovers from the first usually within a short time period (hours, days, weeks) can slow recovery or increase the chances for long-term problems. WHAT CAN HAPPEN IF MY CHILD KEEPS ON PLAYING WITH A CONCUSSION? Athletes with the signs and symptoms of a concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athletes will often under report symptoms of injuries. And concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student-athlete s safety. Athlete s Name (Please print): ID #: Athlete s Signature: Parent or Guardian s Name (Please print): Date: Parent or Guardian s Signature:
6 SOCORRO INDEPENDENT SCHOOL DISTRICT Department of Athletics RETURN TO PLAY GUIDELINES FOR PARENTS TEACH IT S NOT SMART TO PLAY WITH A CONCUSSION. Rest is the key after a concussion. Occasionally athletes, parents, school staff and/or league officials wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don t let your athlete convince you that they re just fine. PREVENT LONG-TERM PROBLEMS. If an athlete has a concussion, their brain needs time to heal. Don t let them return to play the day of the injury and until a health care professional says they are symptom-free and it s OK to return to play. A repeat concussion that occurs before the brain recovers from the first usually within a short time period (hours, days, weeks) can slow recovery or increase the chances for long-term problems. Socorro ISD has developed a protocol for managing concussions. This policy includes a multidiscipline approach involving athletic trainer clearance, physician referral and clearance, and successful completion of activity progressions related to their sport. The following is an outline of this procedure. You son/daughter must pass all of these tests in order to return to sport activity after having a concussion. 1. All athletes who sustain a head injury are required to be evaluated by their primary care physician. They must have a normal physical and neurological exam prior to being permitted to progress activity. This includes athletes who were initially referred to an emergency department. 2. The student will be monitored daily at school by the coach and athletic trainer. His/her teachers will be notified of the injury and what to expect. Accommodations may need to be given according to physician recommendations and observations. 3. The student must be asymptomatic at rest and exertion. 4. Once cleared to begin activity, the student will start a progressive step-by-step procedure outlined in the SISD Concussion Management Policy. The progressions will advance at the rate of one step per day as long as no symptoms become present. The progressions are as follows: Phase 1 1. No activity for a minimum of 7 days regardless of Licensed Physician release. 2. Athlete must be symptom free with physician clearance before starting return-to-play protocol. Phase 2 1. Day 1 - Light aerobic exercise 5 10 minutes on exercise bike or light jogging with no resistance training 2. Day 2 - Moderate Aerobic activity and Resistance training min. running in the gym or on the field with no protective equipment, 20 min. of resistance training may include push-ups and sit ups, No weight lifting. 3. Day 3 - Sports Specific drills. Cutting, sprinting, etc. No uniform or protective equipment 4. Day 4 - Return to Full Controlled Practice 5. Day 5 - Return to full activity. Once the athlete has completed phase 1 2. *Note Athlete progression continues as long as the athlete is asymptomatic at current level. If the athlete experiences any post concussion symptoms, the athlete must wait until they are symptom free for 24 hours and start the progression again at the last symptom free step. If athletes experiences symptoms three times during the return-to-play protocol, they must be re-evaluated by a physician.* Phase 3 Licensed Athletic Trainer and/or Middle School Nurse Clearance
7
8
9
10
The Greenville Hurricanes Athletic Association. Concussion Policy. Injury Prevention and Control. What is a concussion?
The Greenville Hurricanes Athletic Association Concussion Policy Injury Prevention and Control What is a concussion? How do I recognize a possible concussion? Know your concussion ABCs! What can I do to
More informationThe Kansas Legislature has enacted the School Sports Head Injury Prevention Act (hereinafter the Kansas Act ) effective July 1, 2011:
KANSAS STATE HIGH SCHOOL ACTIVITIES ASSOCIATION RECOMMENDATIONS FOR COMPLIANCE WITH THE KANSAS SCHOOL SPORTS HEAD INJURY PREVENTION ACT AND IMPLEMENTATION OF THE NATIONAL FEDERATION SPORTS PLAYING RULES
More informationCCYFL Concussion Information Sheet
CCYFL Concussion Information Sheet Why am I getting this information sheet? You are receiving this information sheet about concussions because of California state law AB 2007, (effective January 1, 2017),
More informationConcussion Management Policy Overview. City School District of Albany Department of Health, Physical Education & Athletics
Concussion Management Policy Overview City School District of Albany Department of Health, Physical Education & Athletics CSDA Concussion Management Policy After 6 months of research and development, the
More informationPresbyterian School of Houston Athletic Department. Concussion Management Protocol
Presbyterian School of Houston Athletic Department Concussion Management Protocol Presbyterian School of Houston Athletic Department Concussion Management Protocol Introduction and Overview Concussion
More informationArlington Public Schools Athletics
Arlington Public Schools Athletics Fact Sheet on Concussions for Parents/Guardians What is a Concussion? A concussion is a brain injury caused by a bump or blow to the head or body. A concussion occurs
More informationCONCUSSION BOARD POLICY 8604
CONCUSSION BOARD POLICY 8604 Policy Concussion management and policy protocols are a standardized method of assessment to ensure an accurate diagnosis and the appropriate management of student-athlete
More informationConcussion Information Sheet
Concussion Information Sheet A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force
More informationTSSA Concussion Information and Signature Form for Coaches/Administrators
TSSA Concussion Information and Signature Form for Coaches/Administrators Public Chapter 148, effective January 1, 2014, requires that school and community organizations sponsoring youth athletic activities
More informationHigh School Guidelines for Sports Concussion Management, Neurocognitive Testing& Return to Play Protocol. Athletic Trainer, Lake Travis ISD
High School Athletic Trainer, Lake Travis ISD Registered Nurse, Lake Travis ISD Dr. Michael Shane Reardon Dell Children s Medical Center Hank Carter Athletic Director, Lake Travis ISD Mary Patin Deputy
More informationIt s better to miss one game than the whole season. What should I do if I think I have a concussion? Concussion facts:
Concussion facts: A concussion is a brain injury that affects how your brain works. A concussion is caused by a bump, blow, or jolt to the head or body. A concussion can happen even if you haven t been
More informationWhen a concussion occurs:
When a concussion occurs: Once an athlete has experienced any type of potential head injury initiate the following checklist: 1. n Remove athlete from all activity and use the Concussion Recognition Tool
More informationPrint or Type. Emergency Information Student s Name Grade Date of Birth Home Address
Athlete s Health Records Pre-participation Physical Exam The Shelby County Interscholastic Athletic Association requires every student-athlete to receive a pre-participation physical exam, including a
More informationVictoria Independent School District Athletic Department Guidelines for Concussion Management
Victoria Independent School District Athletic Department Guidelines for Concussion Management Introduction Approximately 10 percent of all athletes involved in contact sports suffer a Mild Traumatic Brain
More informationCONCUSSION INFORMATION AND SIGNATURE FORM FOR COACHES (Adapted from CDC Heads Up Concussion in Youth Sports )
CONCUSSION INFORMATION AND SIGNATURE FORM FOR COACHES (Adapted from CDC Heads Up Concussion in Youth Sports ) Read and keep this page. Sign and return the signature page. THE FACTS A concussion is a brain
More informationCONCUSSION INFORMATION AND SIGNATURE FORM FOR COACHES (Adapted from CDC Heads Up Concussion in Youth Sports )
CONCUSSION INFORMATION AND SIGNATURE FORM FOR COACHES (Adapted from CDC Heads Up Concussion in Youth Sports ) Read and keep this page. Sign and return the signature page. THE FACTS A concussion is a brain
More informationCONCUSSION and SUDDEN CARDIAC ARREST ACKNOWLEDGEMENT AND SIGNATURE FORM FOR PARENTS AND STUDENT ATHLETES. Sport Participating In (If Known):
Student Athlete s Name (Please Print): CONCUSSION and SUDDEN CARDIAC ARREST ACKNOWLEDGEMENT AND SIGNATURE FORM FOR PARENTS AND STUDENT ATHLETES Sport Participating In (If Known): Date: IC 20-34-7 and IC
More informationWisconsin Lacrosse Federation
The purpose of this policy is to insure the safety of the players and to limit the liability of those protecting the safety of the players. The responsibility of player safety falls on everyone involved
More informationUPPER PERKIOMEN HIGH SCHOOL
UPPER PERKIOMEN HIGH SCHOOL Concussion Management and Return to Play Protocol Recognizing that sport related concussions pose a significant health risk for studentathletes, the Upper Perkiomen School District
More information2017 Youth Soccer Program
Central Klickitat County Parks and Recreation District 2017 Youth Soccer Program For girls and boys ages 4 14 Age division will be determined by child s date of birth on July 31, 2017 Registration forms
More informationMount Michael Benedictine Concussion Management Policy & Protocol
Mount Michael Benedictine Concussion Management Policy & Protocol I. Definition of Concussion a. A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head. A concussion
More informationPlease feel free to contact me if you have any questions. HOME INSTRUCTIONS FOR CONCUSSION. Recommendations for monitoring symptoms at home:
Recommendations for monitoring symptoms at home: What should I do when I m recovering? Physical and mental rest are very important to your recovery. Keep your heart rate low and do not do any physical
More informationConcussions UCLA Steve Tisch BrainSPORT Clinic
Concussions UCLA Steve Tisch BrainSPORT Clinic Concussion facts What is a concussion? A concussion is a traumatic brain injury (TBI) caused by a bump, blow or jolt to the head or by a hit to the body that
More informationWilliam Howard Taft High School
William Howard Taft High School Return To Learn / Return To Play Policy This protocol is intended to provide an outline of the procedures we follow during the course of the school day, as well as contests/matches/events,
More informationStatewide Health Initiative on Concussion Education & Prevention
Statewide Health Initiative on Concussion Education & Prevention PLAY SMART Wisconsin: Statewide Health Initiative on Concussion Education & Prevention was developed by the Brain Injury Association of
More informationWhitnall High School 5000 South 116th St. Greenfield, WI 53228
Concussion Information - When in Doubt, Sit Them Out! 1. Before a student may participate in practice or competition: At the beginning of a season for a youth athletic activity, the person operating the
More informationForney ISD Protocol and Procedures for the Management of the Sports-Related Concussion
Forney ISD Protocol and Procedures for the Management of the Sports-Related Concussion Medical management of sports-related concussion is evolving. Recently, there has been a significant amount of research
More informationFSHISD ATHLETIC DEPARTMENT GUIDELINES FOR CONCUSSION MANAGEMENT
Fort Sam Houston ISD Athletic Department 4005 Winans Rd., San Antonio, TX 78234 Phone: (210) 368-8700 Fax: (210) 368-8741 FSHISD ATHLETIC DEPARTMENT GUIDELINES FOR CONCUSSION MANAGEMENT Concussion Management
More informationSCHOOL CITY OF HOBART
SCHOOL CITY OF HOBART 32 East 7 TH Street, Hobart, IN 46342 Phone: 219-942-8885 Fax: 219-942-0081 http://www.hobart.k12.in.us Building College and Career Ready Brickies 5340.01 F1/page 1 of 5 CONCUSSION
More informationDear Newport News Athletic Parent/Guardian:
Dear Newport News Athletic Parent/Guardian: According to the Children s Hospital of the King s Daughter about one in ten local athletes in contact sports will sustain a concussion during a sports season.
More informationWISD Athletic Department Guidelines for Concussion Management
WISD Athletic Department Guidelines for Concussion Management Introduction Approximately 10 percent of all athletes involved in contact sports suffer a Mild Traumatic Brain Injury (concussion) each season;
More informationINTERCOLLEGIATE ATHLETICS CONCUSSION MANAGEMENT PLAN
INTERCOLLEGIATE ATHLETICS CONCUSSION MANAGEMENT PLAN I. PURPOSE In an effort to better serve the healthcare needs of its student athletes, as well as to adhere to best practices recommended by the National
More informationWhen it comes to concussions, is critical.
When it comes to concussions, knowledge is critical. 1 Be Smart About the Brain Know the Facts A concussion is a traumatic injury to the brain that affects how the brain functions. Early diagnosis and
More informationPurpose: The purpose of this policy is to establish a protocol for defining concussions, recognizing symptoms of concussions, and determining the
Purpose: The purpose of this policy is to establish a protocol for defining concussions, recognizing symptoms of concussions, and determining the return to play of an athlete following a concussion at
More informationColiseum SC Concussion Protocol Signs and Symptoms
Coliseum SC Concussion Protocol Signs and Symptoms Athletes who experience one or more of the signs or symptoms listed below after a bump, blow, or jolt to the head or body may have a concussion. SIGNS
More informationSports Concussion Management Plan. P a g e 1
Sports Concussion Management Plan P a g e 1 P a g e 2 A. Sports Concussion Management Plan Albemarle County Public Schools (ACPS) recognizes that a concussion is a brain injury that is characterized by
More informationCONCUSSION/HEAD INJURY AND HEAT ILLNESS GUIDELINES
CONCUSSION/HEAD INJURY AND HEAT ILLNESS GUIDELINES WHAT IS A CONCUSSION? A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head, or by a blow to the body with the
More informationPARENT & ATHLETE CONCUSSION INFORMATION SHEET WHAT IS A CONCUSSION? A concussion is a type of traumatic brain injury that changes the way the brain normally works. A concussion is caused by a bump, blow,
More informationCEDARVILLE UNIVERSITY CONCUSSION MANAGEMENT GUIDELINES
Concussion Management CEDARVILLE UNIVERSITY CONCUSSION MANAGEMENT GUIDELINES Aug. 2015 1. Cedarville University will require all student-athletes to sign a statement in which studentathletes accept the
More informationCONCUSSION IN YOUTH SPORTS
Canada Basketball and our Provincial/ Territorial Sport Organizations understand that having a concussion policy is crucial to the health and wellness of our young athletes. Through the amalgamation of
More informationVENUS ISD CONCUSSION POLICY
VENUS ISD CONCUSSION POLICY Introduction The Centers for Disease Control (CDC) estimates that there are approximately 300,000 cases of mild traumatic brain injury (MTBI) or concussions annually in the
More informationReturn-to-Play Protocol After Concussion/mild TBI
Return-to-Play Protocol After Concussion/mild TBI Return to activity and play is a medical decision. The athlete must meet all of the following criteria to progress to activity: Asymptomatic at rest and
More informationConcussion Procedures
Concussion Procedures W a l l e r H i g h S c h o o l 2 0 9 5 0 F i e l d S t o r e R o a d 936-3 7 2-3 6 5 4 936-3 7 2-4 1 1 4 9 / 1 / 2 0 1 1 Waller Independent School District Concussions received by
More informationDelaware State University
1 Delaware State University University Area(s) Responsible: Athletics Policy Number & Name: 11-02: Sport Concussion Policy Approval Date: 1/30/2013 Revisions: _ Reviewed: Related Policies & Procedures:
More informationPUYALLUP VIKINGS LACROSSE CLUB Concussion and Sudden Cardiac Arrest Information Sheet
PUYALLUP VIKINGS LACROSSE CLUB Concussion and Sudden Cardiac Arrest Information Sheet A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the
More informationINFORMATION AND SIGNATURE FORM FOR STUDENT-ATHLETES & PARENTS/LEGAL GUARDIANS (Adapted from CDC "Heads Up Concussion in Youth Sports")
INFORMATION AND SIGNATURE FORM FOR STUDENT-ATHLETES & PARENTS/LEGAL GUARDIANS (Adapted from CDC "Heads Up Concussion in Youth Sports") Public Chapter 148, effective January 1, 2014, requires that school
More informationConcussion Protocol. Signs and Symptoms. Pre-Concussion Management
Concussion Protocol In recent years, we have seen an increase in concussions. A concussion is defined by The Children s Hospital of Philadelphia (CHOP) as a mild traumatic brain injury (mtbi) caused by
More informationJefferson County School District Protocol and Procedures for Management of Sports-Related Concussions
Jefferson County School District 509J 390 SE 10 th St. Madras, OR 97741 Jefferson County School District Protocol and Procedures for Management of Sports-Related Concussions Medical management of a sports-related
More informationApproved to begin Return to Learn and/or Return to Play. Approved to only return to class, NOT athletic competition
Buffalo Tri-City CUSD #1 Concussion Form Information This form is to be filled out by the head coach, assistant coach, AD, or district administrator that is in charge at the time of the incident. The parent
More informationBishop O Dowd Head Injury and Concussion Management Packet
Bishop O Dowd Head Injury and Concussion Management Packet Dear Parent/Guardian, Your student has been assessed by a Certified Athletic Trainer (ATC) for a possible head injury and concussion sustained
More informationCONCUSSION POLICY AND PROCEDURES
NORTHEAST METROPOLITAN REGIONAL VOCATIONAL SCHOOL 100 HEMLOCK ROAD WAKEFIELD, MA 01880 CONCUSSION POLICY AND PROCEDURES 1/2016 12/2017 Reviewed by Committee Members: David DiBarri Deputy Director- Principal
More informationLittle League Concussion Information Sheet
Little League Concussion Information Sheet Why am I getting this information sheet? You are receiving this information sheet about concussion because of California Assembly Bill 2007 (2016), which added
More informationINTERCOLLEGIATE ATHLETICS CONCUSSION ACKNOWLEDGEMENT AND STATEMENT
ACKNOWLEDGEMENT AND STATEMENT A FACT SHEET FOR STUDENT-ATHLETES WHAT IS A? A concussion is a brain injury that: Is caused by a blow to the head or body -From contact with another player, hitting a hard
More informationCONCUSSION INFORMATION When in Doubt, Sit Them Out!
CONCUSSION INFORMATION When in Doubt, Sit Them Out! A concussion is a type of traumatic brain injury that interferes with normal function of the brain. All concussions are brain injuries. The WIAA recommends
More informationSigns and Symptoms of Concussion
Signs and Symptoms of Concussion These signs and symptoms following a witnessed or suspected blow to the head or body are indicative of probable concussion. Signs (observed by others) Appears dazed or
More information1. Begin light aerobic exercise such as walking, stationary bike, etc. No resistance training.
POLICY: Any athlete displaying signs or symptoms of a concussion, or if there is a high suspicion for concussion, an athlete will not be returned to competition or practice until they have written clearance
More informationApproximately 10 percent of all athletes involved in contact sports suffer a Mild Traumatic Brain Injury (concussion) each season; some estimates are
Approximately 10 percent of all athletes involved in contact sports suffer a Mild Traumatic Brain Injury (concussion) each season; some estimates are as high as 19 percent. Because many mild concussions
More informationSUBJECT: CONCUSSION MANAGEMENT POLICY
SUBJECT: CONCUSSION MANAGEMENT POLICY The Board of Education of the Plainview-Old Bethpage Central School District recognize that mild traumatic brain injuries (commonly referred to as concussions ) and
More informationThe Master s Academy Concussion Policy
The Master s Academy Concussion Policy Ann Williams,M.S.N., R.N. Robert O Quinn, MS, ATC, LAT Updated 2/6/2018 Outline I. Abbreviated policy II. Introduction III. Prevention and Education IV. Recognition
More informationWest Nashville Sports League
West Nashville Sports League Winter Soccer Addendum Packet 2018 LEAVE THIS PACKET HERE TONIGHT! Head Coach s Name: Division: WNSL conducts background checks for all HEAD coaches. Please keep in mind that
More informationCONCUSSION PROTOCOL STEPS FOR RETURN TO PLAY
Winnacunnet High School Concussion Protocol All coaches must take the NFHS Concussion course prior to working with students in their coaching season. Coaches must retake the course on even numbered years.
More informationIt's better to miss one game than the whole season. A Fact Sheet for ATHLETES. Get a medical check up. A doctor or health care
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION A Fact Sheet for ATHLETES WHAT IS A CONCUSSION? A concussion is a brain injury that: Is caused by a bump or blow
More informationPARENTS FACT SHEET FOR YOUTH SPORTS ON CONCUSSIONS
PARENTS FACT SHEET FOR YOUTH SPORTS ON CONCUSSIONS This sheet has information to help protect your children or teens from concussion or other serious brain injury. What Is a Concussion? A concussion is
More informationTexas State University Concussion Program for Varsity Athletes
Administrative Considerations o Emergency Action Plan placed in all venues including the Concussion Plan for all high risk sports. o Coaching education regarding EAP & Concussion Plan including signs &
More informationHamilton-Wentworth District School Board. Athletics Concussion Protocol. Part I
Hamilton-Wentworth District School Board Athletics Concussion Protocol Part I Introduction Concussions are brain injuries caused by excessive, rapid movement of the brain inside the skull. This movement
More informationMilford Public Schools Concussion Policy and Procedures. Department of Athletics
Milford Public Schools Concussion Policy and Procedures Department of Athletics The mission of this document is to make known the procedures for prevention, recognition and management of MTBI (mild traumatic
More informationNCAA Sports. Participation Forms. Required for Participation in NCAA Sports BRYN ATHYN COLLEGE HEALTH SERVICES 2945 COLLEGE DRIVE, BRYN ATHYN PA 19009
NCAA Sports Participation Forms Required for Participation in NCAA Sports BRYN ATHYN COLLEGE HEALTH SERVICES 2945 COLLEGE DRIVE, BRYN ATHYN PA 19009 (Page 1 of 6) Athletic Department Participation Agreement,
More informationIntroduction. Second Impact Syndrome
Introduction The Centers for Disease Control (CDC) estimates that there are approximately 300,000 cases of mild traumatic injury (MTBI) or concussions annually in the United States as the result of participation
More informationSt. John Fisher College Intercollegiate Athletics Concussion Management Protocol
St. John Fisher College Intercollegiate Athletics Concussion Management Protocol Definition of Concussion Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic
More informationEagle High School Lacrosse Concussion Management Plan
! Eagle High School Lacrosse Concussion Management Plan August 2018 Contents (1) Mandatory Parent/Athlete Meeting 1 (2) Recommended Baseline Testing 2 (3) Concussion Training for Athletic Trainers and
More informationConcussion Management Protocol
Concussion Management Protocol We at Total Sports Experience desire a safe return to play for all sick or injured athletes. Research has shown that an athlete's coordination, balance and/or cognitive functioning
More informationDavidson College Sports Medicine Concussion Management Policy
Davidson College Sports Medicine Concussion Management Policy Davidson College practices concussion management care based on the most current research and consensus statements from noted concussion experts.
More informationSPRINGFIELD CLINIC S
SPRINGFIELD CLINIC S HEAD INJURY MANAGEMENT GUIDE FOR PARENTS Given the complexities of concussion management, Springfield Clinic recognizes the importance of managing concussions on an individualized
More informationConcussion Identification, Management and Return to Play at North Hunterdon-Voorhees Regional HS District
Concussion Identification, Management and Return to Play at North Hunterdon-Voorhees Regional HS District In tandem with the New Jersey Interscholastic Athletic Association and the National Athletic Trainers
More informationCoastal Carolina University Athletic Training Department Policy and Procedure Manual Concussion Management Revised/Reviewed 6/2012
Coastal Carolina University Athletic Training Department Policy and Procedure Manual Concussion Management Revised/Reviewed 6/2012 INTRODUCTION: Concussion classification, management, and protocols have
More informationCDC Heads UP Concussion Training
CDC Heads UP Concussion Training For Special Olympics Kentucky Kentucky 1 What is a concussion? A type of Traumatic Brain Injury has possible causes such as a: bump to the head blow to the head jolt to
More informationThe University of North Carolina at Chapel Hill Sport Concussion Policy
The University of North Carolina at Chapel Hill Sport Concussion Policy Developed by the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center and Division of Sports Medicine Updated August
More informationGENERAL RETURN TO PLAY LAW INFORMATION FOR LEAGUES AND COACHES
GENERAL RETURN TO PLAY LAW INFORMATION FOR LEAGUES AND COACHES Leagues are responsible for implementing a protocol to ensure (1) that each league coach is trained as required by the law; (2) that the coaches
More informationSTAMFORD CENTRAL SCHOOL CONCUSSION POLICY
STAMFORD CENTRAL SCHOOL CONCUSSION POLICY Revised October 14, 2015 Page 1 Management of Sports-Related Concussions StamfordCentralSchool District Medical management of sports-related concussion continues
More informationNotre Dame of Maryland University Athletics Concussion Management Protocol
Notre Dame of Maryland University Athletics Concussion Management Protocol Neuropsychological (NP) Baseline Testing: All NCAA sports will utilize baseline NP testing. All athletes will receive baseline
More informationParamus Athletics. Paramus High School Athletic Department Protocol and Procedures for Management of Sports - Related Concussion
Paramus Athletics Paramus High School Athletic Department Protocol and Procedures for Management Medical management of sports-related concussions is evolving. In recent years, there has been significant
More informationLoss of consciousness (LOC) Poor recall for events prior to injury or after injury
NAIA Championship Concussion Policy Concussions can be serious and potentially life threatening injuries in sports. Research indicates that if concussion symptoms are appropriately managed, an individual
More informationCarleton College Concussion Safety Protocol
Carleton College Introduction Carleton College is committed to ensuring the health and safety of its student-athletes. To this end, and in accordance with NCAA legislation [Division III Constitution 3.2.4.16],
More informationPost Concussion Instructions and Return to Play Clearance Form. To: Parent/Guardian: Page 1. From:, at School
Post Concussion Instructions and Return to Play Clearance Form To: Parent/Guardian: From:, at School Name of School Representative* Name of School, Position of School Representative* Phone Number of School
More informationNEBRASKA SCHOOL ACTIVITIES ASSOCIATION Member of the National Federation of State High School Associations
NEBRASKA SCHOOL ACTIVITIES ASSOCIATION Member of the National Federation of State High School Associations 500 Charleston P.O. Box 85448 Lincoln, Nebraska 68501 Phone: 402-489-0386 Fax: 402-489-0934 E-mail:
More informationGrasso Technical High School Athlete Eligibility Packet Sign-off. Student Name: Grade: Sport:
Grasso Technical High School Athlete Eligibility Packet Sign-off Student Name: Grade: Sport: All students and parents must read and sign all attached documents and parents must sign this cover sheet in
More informationCity of Norwalk Recreation Department. Concussion Guidelines for Youth Athletics
City of Norwalk Recreation Department Concussion Guidelines for Youth Athletics I. INTRODUCTION. In recognition of the dangers posed to youth athletes as a result of sports related head injuries, the City
More informationConcussion Management Protocol
Concussion Management Protocol Lakeland Athletic Training Services Patient Information www.lakelandhealth.org 2 Concussion Home Care Instructions Dear Parent or Guardian: concussion during has possibly
More informationAthlete: n Parent/Guardian Contacted: Name Date. Notes:
When a concussion occurs: Any school athlete who has been removed from a sport competition or practice session shall not return to competition or practice until the athlete is evaluated by a health care
More informationTown of West Seneca Youth Engaged in Service New Volunteer Orientation Guide
Town of West Seneca Youth Engaged in Service New Volunteer Orientation Guide Important Information: Youth & Recreation Department Office Phone Number: 674-6086 Program Email: wsyes@twsny.org Program Information
More informationConcussion Information any student suspected of having a concussion must be immediately removed from play.
Concussion Information (BP/AR 6145.22) As medical management of sports-related concussion continues to evolve. Recently, there has been a significant amount of new research regarding sports-related concussions
More informationUCSF PLAYSAFE SPORTS MEDICINE
Dear Parent/Guardian, Your son/daughter has been assessed by a certified athletic trainer (ATC) as having sustained a concussion. The following packet details how to manage a head injury of this kind.
More informationPleasantville School District Concussion Procedures of Parents
Pleasantville School District Concussion Procedures of Parents This document is a brief outline on concussions and the procedure the district follows when a student suffers a concussion. By New York State
More informationTMPW Xplorers Basketball Concussion Management Plan
TMPW Xplorers Basketball Concussion Management Plan November 2017 Contents (1) Mandatory Parent / Athlete Education 1 & 2 (2) Recommended Baseline Testing 3 (3) Concussion Training for Athletic Trainers
More informationCypress-Fairbanks Independent School District
Cypress-Fairbanks Independent School District Concussion Oversight Team Medical Advisor Paul Gill, MD Board Certified in Neurology 21212 North West Freeway Suite 515 Cypress, Tx 77429 832-912-7777 High
More informationConcussion Management Guidelines January 10, 2013
Concussion Management Guidelines January 10, 2013 1. UT Martin will require student-athletes to sign a statement in which student-athletes accept the responsibility for reporting their injuries and illnesses
More informationINFORMATION REGARDING CONCUSSION PROTOCOL. Educational Services June 7, 2016 Information #2 Page 1 of 1
TITLE: INFORMATION REGARDING CONCUSSION PROTOCOL Educational Services June 7, 2016 Information #2 Page 1 of 1 Prepared by: Deborah Salgado, Director of Secondary Education Background Information Assembly
More informationLee County School District: Athletic Department Protocol and Procedures for Management of Sports-Related Concussion
Lee County School District: Athletic Department Protocol and Procedures for Management of Sports-Related Concussion Medical management of sports-related concussions are evolving. In recent years, there
More informationALABAMA INDEPENDENT SCHOOL ASSOCIATION PHYSICAL EXAMINATION FORM
ALABAMA INDEPENDENT SCHOOL ASSOCIATION PHYSICAL EXAMINATION FORM (Completed by Physician) HEIGHT WEIGHT BLOOD PRESSURE PULSE (SYSTOLIC/DIASTOLIC) (BEATS/MIN) VISION: RIGHT 20/ LEFT 20/ CORRECTED UNCORRECTED
More informationSTUDENT/ATHLETE Medical Release Form. Alabama Independent School Association
STUDENT/ATHLETE Medical Release Form 1500 East Fairview Avenue Huntingdon College Montgomery, AL 36106 (334) 833-4080 Fax (334) 833-4086 www.aisaonline.org Alabama Independent School Association Federal
More information