Player Concussion

First and last names of player *

First and last name of parent *

I have read the concussion symptoms on the Concussion Information Sheet. *

http://www.tssaa.org/wp-content/uploads/concussionparents.pdf

A concussion is a brain injury which should be reported to my parents, my coach(es) or a medical professional if one is available. *

I will/my child will need written permission from a health care provider to return to play or practice after a concussion. *

Most concussions take days or weeks to get better. A more serious concussion can last for months or longer. *

After a bump, blow or jolt to the head or body an athlete should receive immediate medical attention if there are any danger signs such as loss of consciousness, repeated vomiting, or a headache that gets worse. *

After a concussion, the brain needs time to heal. I undestand that I am/my child is much more likely to have another concussion or more serious brain injuty if return to play or practice occurs before the concussion symptoms go away. *

Sometimes repeat concussion can cause serious and long-lasting problems and even death. *

PLAYER NAME THAT MATCHES ABOVE NAME ---I acknowledge that typing my name is my signature agreeing that I have read and agree with the concussion protocol. *

player name and date

Phone

Player Concussion

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