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Concussion Information Sheet

Adapted from the WAYSA, CDC and the 3rd International Conference on Concussion in Sport



Concussion Information & Awareness Form

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:


“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


Change in sleep patterns


“Don’t feel right”

Fatigue or low energy


Nervousness or anxiety


More emotional


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 incoordination

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


What can happen if my child keeps on playing with a concussion or returns to 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 athlete 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.


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 new “Zackery Lystedt Law” in Washington now requires the consistent and uniform

implementation of long and well-established return to play concussion guidelines that have been recommended for

several years:

“a youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall

be removed from competition at that time”


“…may not return to play until the athlete is evaluated by a licensed heath care provider trained in the

evaluation and management of concussion and received written clearance to return to play from that

health care provider”.

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. When in doubt, the athlete sits out.

For current and up-to-date information on concussions you can go to:

_____________________________ _____________________________ _____________

Student-athlete Name Printed Student-athlete Signature Date

_____________________________ ______________________________ _____________

Parent or Legal Guardian Printed Parent or Legal Guardian Signature Date