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Golf Registration 2020 5-8

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Concussion Information Sheet
Adapted from the CDC and the 3rd International Conference on Concussion in Sport
Document created 7/1/2011, Reviewed 4/24/2013, Reviewed 7/16/2015
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 transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.
Symptoms may include one or more of the following:
• Headaches
• “Pressure in head”
• Nausea or vomiting
• Neck pain
• Balance problems or dizziness
• Blurred, double, or fuzzy vision
• Sensitivity to light or noise
• Feeling sluggish or slowed down
• Feeling foggy or groggy
• Drowsiness
• Change in sleep patterns
• Amnesia
• “Don’t feel right”
• Fatigue or low energy
• Sadness
• Nervousness or anxiety
• Irritability
• More emotional
• Confusion
• Concentration or memory problems (forgetting game plays)
• Repeating the same question/comment
Signs observed by teammates, parents and coaches include:
• Appears dazed
• Vacant facial expression
• Confused about assignment
• Forgets plays
• Is unsure of game, score, or opponent
• Moves clumsily or displays in coordination
• Answers questions slowly
• Slurred speech
• Shows behavior or personality changes
• Can’t recall events prior to hit
• Can’t recall events after hit
• Seizures or convulsions
• Any change in typical behavior or personality
• Loses consciousness
Concussion Information Sheet
Adapted from the CDC and the 3rd International Conference on Concussion in Sport
Document created 7/1/2011, Reviewed 4/24/2013, Reviewed 7/16/2015
What can happen if my child keeps on playing with a concussion or returns too soon?
Athletes with the signs and symptoms of 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 fail to report
symptoms of injuries. Concussions are no different. As a result, education of administrators,
coaches, parents and students is the key to student-athlete’s safety.
If you think your child has suffered a concussion
Any athlete even suspected of suffering a concussion should be removed from the game or
practice immediately. No athlete may return to activity after an apparent head injury or
concussion, regardless of how mild it seems or how quickly symptoms clear, without medical
clearance. Close observation of the athlete should continue for several hours. The Return-to-
Play Policy of the IESA and IHSA requires athletes to provide their school with written clearance
from either a physician licensed to practice medicine in all its branches or a certified athletic
trainer working in conjunction with a physician licensed to practice medicine in all its branches
prior to returning to play or practice following a concussion or after being removed from an
interscholastic contest due to a possible head injury or concussion and not cleared to return to
that same contest. In accordance with state law, all schools are required to follow this policy.
You should also inform your child’s coach if you think that your child may have a concussion.
Remember it’s better to miss one game than miss the whole season. And when in doubt, the
athlete sits out.
For current and up-to-date information on concussions you can go to:
http://www.cdc.gov/ConcussionInYouthSports/
Student/Parent Consent and Acknowledgements
By signing this form, we acknowledge we have been provided information regarding
concussions.
Student
Student Name (Print): Grade:
Student Signature: Date:
Parent or Legal Guardian
Name (Print):
Signature: Date:
Relationship to Student:
Each year IESA member schools are required to keep a signed Acknowledgement and Consent form and a current
Pre-participation Physical Examination on file for all student athletes.
Please submit $40 Fee through PayPal at the bottom
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There will be no fee this year unless your child qualifies for sectionals

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Golf Registration 2020 5-8