Concussion Form for Students

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“Ensuring learning while challenging each student to achieve full potential”
Pullman School District No. 267 240 SE Dexter Street, Pullman, WA 99163
Please read carefully the following information. Sign on page 2 to acknowledge that you understand and return to your Coach.
HEADS UP: CONCUSSION IN YOUTH SPORTS
A Fact Sheet for ATHLETES
WHAT IS A CONCUSSION? A concussion is a brain injury that: • • • • • • • • • • • • • • • • Is caused by a bump or blow to the head Can change the way your brain normally works Can occur during practices or games in any sport Can happen even if you haven’t been knocked out Can be serious even if you’ve just been dinged Headache or pressure in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Bothered by light Bothered by noise Feeling sluggish, hazy, foggy, or groggy Difficulty paying attention Memory problems Confusion Does not feel right
WHAT ARE THE SYMPTOMS OF A CONCUSSION?
WHAT SHOULD I DO IF I THINK I HAVE A CONCUSSION? • Tell your coaches and your parents. Never ignore a bump or blow to the head even if you feel fine. Also, tell your coach if one of your teammates might have a concussion. • Get a medical check up. A doctor or health care professional can tell you if you have a concussion and when you are OK to return to play. • Give yourself time to get better. If you have had a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have a second concussion. Second or later concussions can cause damage to your brain. It is important to rest until you get approval from a doctor or health care professional to return to play. HOW CAN I PREVENT A CONCUSSION? Every sport is different, but there are steps you can take to protect yourself. • • Follow your coachs rules for safety and the rules of the sport. Practice good sportsmanship at all times.
• Use the proper sports equipment, including personal protective equipment (such as helmets, padding, shin guards, and eye and mouth guards). In order for equipment to protect you, it must be: o o o The right equipment for the game, position, or activity Worn correctly and fit well Used every time you play
Its better to miss one game than the whole season. For more information and to order additional materials free-of-charge, visit:www.cdc.gov/ConcussionInYouthSports For more detailed information on concussion and traumatic brain injury, visit: http://www.cdc.gov/injury
I have read and understand the above information regarding concussions. Student______________________________________________Date_____________
Print name______________________________________________________________