Concussion Consent Form

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PRE-SEASON CONCUSSION EDUCATION SHEET

You are being asked to read and sign this form because you participate or are planning to participate in a Softball Canada event or play on a Softball Canada team. Please read the information below and fill out the form to acknowledge you have read this important information.

WHAT IS A CONCUSSION?

A concussion is a brain injury that can’t be seen on x-rays, CT or MRI scans. It affects the way an athlete thinks and can cause a variety of symptoms.

WHAT CAUSES A CONCUSSION?

Any blow to the head, face or neck, or somewhere else on the body that causes a sudden jarring of the head may cause a concussion. Examples include getting body-checked in hockey or hitting one’s head on the floor in gym class.

WHEN SHOULD I SUSPECT A CONCUSSION?

A concussion should be suspected in any athlete who sustains a significant impact to the head, face, neck, or body and reports ANY symptoms or demonstrates ANY visual signs of a concussion. A concussion should also be suspected if an athlete reports ANY concussion symptoms to one of their peers, parents, teachers, or coaches or if anyone witnesses an athlete exhibiting ANY of the visual signs of concussion. Some athletes will develop symptoms immediately while others will develop delayed symptoms (beginning 24-48 hours after the injury).

WHAT ARE THE SYMPTOMS OF A CONCUSSION?

A person does not need to be knocked out (lose consciousness) to have had a concussion. Common symptoms include:

  • Headaches or head pressure
  • Easily upset or angered
  • Dizziness
  • Sadness
  • Nausea and vomiting
  • Nervousness or anxiety
  • Blurred or fuzzy vision
  • Feeling more emotional
  • Sensitivity to light or sound
  • Sleeping more or sleeping less
  • Balance problems
  • Having a hard time falling asleep
  • Feeling tired or having no energy
  • Difficulty working on a computer
  • Not thinking clearly
  • Difficulty reading
  • Feeling slowed down
  • Difficulty learning new information

WHAT ARE THE VISUAL SIGNS OF A CONCUSSION?

Visual signs of a concussion may include:

  • Lying motionless on the playing surface
  • A blank or vacant stare
  • Slow to get up after a direct or indirect hit to the head
  • Balance, gait difficulties, motor incoordination, stumbling, slow labored movements
  • Disorientation or confusion or inability to respond appropriately to questions
  • Facial injury after head trauma
  • Clutching head

WHAT SHOULD I DO IF I SUSPECT A CONCUSSION?

If any athlete is suspected of sustaining a concussion during sports they should be immediately removed from play. Any athlete who is suspected of having sustained a concussion during sports must not be allowed to return to the same game or practice.

It is important that ALL athletes with a suspected concussion undergo medical assessment by a medical doctor or nurse practitioner, as soon as possible. It is also important that ALL athletes with a suspected concussion receive written medical clearance from a medical doctor or nurse practitioner before returning to sport activities.

WHEN CAN THE ATHLETE RETURN TO SCHOOL AND SPORTS?

It is important that all athletes diagnosed with a concussion follow a step-wise return to school and sports-related activities that includes the following Return-to-School and Return-to-Sport Strategies. It is important that youth and adult student-athletes return to full-time school activities before progressing to stage 5 and 6 of the Return-to-Sport Strategy.

Return-to-School Strategy

RtSchool FR

Sport-Specific Return-to-Sport Strategy

RTSport

HOW LONG WILL IT TAKE FOR THE ATHLETE TO RECOVER?

Most athletes who sustain a concussion will make a complete recovery within 1-2 weeks while most youth athletes will recover within 1-4 weeks. Approximately 15-30% of patients will experience persistent symptoms (>2 weeks for adults; >4 weeks for youth) that may require additional medical assessment and management.

HOW CAN I HELP PREVENT CONCUSSIONS AND THEIR CONSEQUENCES?

Concussion prevention, recognition, and management require athletes to follow the rules and regulations of their sport, respect their opponents, avoid head contact, and report suspected concussions.

TO LEARN MORE ABOUT CONCUSSIONS PLEASE VISIT:

Parachute Canada: www.parachutecanada.org/concussion

SIGNATURES:

The following signatures certify that the athlete and his/her parent or legal guardian (if under 18) have reviewed the above information related to concussion.

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