Concussion Information Statement | Walnut Grove Christian School

INFORMATION AND SIGNATURE FORM FOR STUDENT-ATHLETES AND PARENTS/LEGAL GUARDIANS
(Adapted from CDC “Heads Up Concussion in Youth Sports”)

South Carolina State Law requires that schools sponsoring athletics activities establish guidelines to inform and educate coaches, athletes, parents, and other adults involved in athletics about the nature, risk and symptoms of concussion/head injury.

Please read and regularly review the information on this page and use the signature form below to submit acknowledgement to the school.

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 or jolt to the head or body that causes the head and brain to move rapidly back and forth. Even a “ding,” “getting your bell rung” or what seems to be a mild bump or blow to the dead can be serious.

DID YOU KNOW?

  • Most concussions occur without loss of consciousness.
  • Athletes who have, at any point in their lives, had a concussion have an increased risk for another concussion.
  • Young children and teens are more likely to get a concussion and take longer to recover than adults.

WHAT ARE THE SIGNS AND SYMPTOMS OF CONCUSSION?

Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until hours or days after the injury.

If an athlete reports one or more symptoms of concussion listed below after a bump, blow or jolt to the head or body, he/she should be kept out of play the day of the injury and until a health care provider* says he/she is symptom-free and it’s okay to return to play.

 

SIGNS OBSERVED BY COACHING STAFF SYMPTOMS REPORTED BY ATHLETES
Appears dazed or stunned Headache or ‘pressure’ in head
Is confused about assignment or position Nausea or vomiting
Forgets an instruction Balance problems or dizziness
Is unsure of game, score, or opponent Double or blurry vision
Moves clumsily Sensitivity to light
Answers questions slowly Sensitivity to noise
Loses consciousness, even briefly Feeling sluggish, hazy, foggy or groggy
Shows mood, behavior or personality changes Concentration or memory problems
Can’t recall events prior to hit or fall Confusion
Concussion screening is 10% below baseline Just not ‘feeling right’ or ‘feeling down’

*Health care provider means a South Carolina licensed medical doctor, osteopathic physician or clinical
neuropsychologist with concussion training.

CONCUSSION DANGER SIGNS

In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. An athlete should receive immediate medical attention after a bump, blow or jolt to the head or body if he/she exhibits any of the following danger signs:

  • One pupil larger than the other
  • Is drowsy or cannot be awakened
  • A headache that not only does not diminish, but gets worse
  • Weakness, numbness or decreased coordination
  • Repeated vomiting or nausea
  • Slurred speech
  • Convulsions or seizures
  • Cannot recognize people or places
  • Becomes increasingly confused, restless or agitated
  • Has unusual behavior
  • Loses consciousness (even a brief loss of consciousness should be taken seriously)

*If a parent/guardian is not present at the time the student exhibits any of these danger symptoms, a member of the athletic staff will call 911 and accompany the student until a parent/guardian arrives. If a parent/guardian is present, then he/she will have the choice to call 911 or to transport the student to a medical facility himself/herself.

WHY SHOULD AN ATHLETE REPORT HIS OR HER SYMPTOMS?

If an athlete has a concussion, his/her brain needs time to heal. While an athlete’s brain is still healing, he/she is much more likely to have another concussion. Repeat concussions can increase the time it takes to recover. In rare cases, repeat concussions in young athletes can result in brain swelling or permanent damage to their brains. They can even be fatal.

REMEMBER:
Concussions affect people differently.
While most athletes with concussion recover quickly and fully, some will have symptoms that last for days, or even weeks. A more serious concussion can last for months or longer.

WHAT SHOULD YOU DO IF YOU THINK YOUR ATHLETE HAS A CONCUSSION?

If you suspect that an athlete has a concussion, remove the athlete from play and seek medical attention. Do not try and judge the severity of the injury yourself. Keep the athlete out of play the day of the injury and until a health care provider* says he/she is symptom-free and it’s OK to return to play.

Rest is key to helping an athlete recover from concussion. Exercising or activities that involve a lot of concentration such as studying, working on the computer, texting, reading or playing video games may cause concussion symptoms to reappear or get worse. After a concussion, return to sports and school is a gradual process that should be managed and monitored by a health care professional.

*Health care provider means a South Carolina licensed medical doctor, osteopathic physician or clinical neuropsychologist with concussion training.

STUDENT/ATHLETE AND PARENT/LEGAL GUARDIAN CONCUSSION STATEMENT

Athletes will not be allowed to participate in athletics until form has been signed and returned to coach. (one form is required for each athlete)

  • After reading the concussion information provided on this web page, I am aware of the following information:
  • Student/Athlete Acknowledgements

    Type your initials (minimum 2 initials) into each box to acknowledge.
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  • Parent/Legal Guardian Acknowledgements

    Type your initials (minimum 2 initials) into each box to acknowledge.
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  • Note: The ESIGN Act is a federal law passed in 2000. It grants legal recognition to electronic signatures and records if all parties to a contract choose to use electronic documents and to sign them electronically. Your computer's IP address will be captured for verification purposes as a result of submitting this form. This signature is legally binding.
  • Date Format: MM slash DD slash YYYY