Concussion Statement

Email address *

Name *

Sport: *

Role: *

After reading the NCAA Concussion fact sheet and reviewing the CRC Concussion Management Protocol, I am aware of the following information:

A concussion is a brain injury which athletes should report to the medical staff *

A concussion can affect the athlete's ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. I cannot see a concussion, but I might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury *

I will not, knowingly, allow the athlete to return to play in a game or practice if he/she has received a blow to the head or body that results in concussion-related symptoms. *

Athletes shall not return to play in a game or practice unless cleared by the certified athletic trainer. Doctor's recommendations, if available, can be used by the certified athletic trainer in making a final determination of a return to play. Coaches are not cleared to make any medical decisions. *

If I suspect one of my athletes has a concussion, it is my responsibility to have that athlete see the medical staff. *

I will encourage my athletes to report any suspected injuries and illnesses to the medical staff, including signs and symptoms of concussions. *

Following a concussion, the brain needs time to heal. Concussed athletes are much more likely to have a repeat concussion if they return to play before their symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage or death. *

I am aware that athletes diagnosed with a concussion will be assessed at the CRC Athletic Training Room once symptoms have resolved. Athletes will begin a graduated return to play protocol following full recovery of symptoms. *

I have read and understand the CRC Concussion Management Protocol. *

I have read and understand the NCAA Concussion Fact Sheet *

Name of Coach: *

Date: *

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