New Kent Middle School Student-Athlete Concussion Aknowledgement

New Kent Middle School
Student-Athlete Concussion Acknowledgement

Due to the complexity of the injury and ever-growing research, a unanimous definition of concussion does not exist. A concussion can be caused by a direct or indirect hit to the head or body and can result in a disturbance and/or impairment in neurologic function. When an athlete sustains a concussion, the brain suddenly shifts or shakes inside the skull and can hit against the skull’s bony surface. A hard hit to the body can result in an acceleration and/or deceleration injury when the brain brushes against bone protuberances inside the skull. The exact recovery period from this trauma is unclear and will vary from individual to individual.

Symptoms of a Concussion:
Following a concussion, the athlete may experience a variety of symptoms. Most concussions occur without a loss of consciousness. It is important to remember that some symptoms may appear right away and some may be delayed. Symptoms, as well as symptom severity, may differ between individuals; however, a combination of symptoms classically occurs.

Some Symptoms and Signs Include:
Symptoms: Signs:
- Nausea/vomiting - Difficulty concentrating
- Dizziness - Inappropriate playing behavior
- Confusion - Decreased playing ability
- Fatigue - Inability to perform daily activities
- Lightheadedness - Reduced attention
- Headaches - Cognitive and memory dysfunction
- Irritability - Sleep disturbances
- Disorientation - Vacant stare
- Seeing bright lights/stars - Loss of bowel and/or bladder control
- Feeling of being stunned - Personality change
- Depression - Unsteadiness of gait
- Ringing in the ears - Slurred/incoherent speech
- Loss of consciousness

Due to the serious nature of this injury and potential catastrophic results of returning to activity, concussions need to be recognized and diagnosed as soon as possible. It is required that student-athletes be truthful and forthcoming about their symptoms as soon as they present. If/when they are diagnosed with a concussion, student-athletes must report symptoms each day until they are cleared for full activity by a physician. Failure to do so may increase the risk of brain damage and post-traumatic concussion syndrome. The student-athlete will not continue with athletic participation after a concussion until cleared to do so by a physician.

Students and parents must initial beside each statement about concussions below signifying their understanding of each:

______  ______ I understand that it is my responsibility to report all injuries and illnesses to my 

    coach and/or physician.

______  ______ A concussion is a brain injury, and I am responsible for reporting this to my 


______  ______ A concussion can affect my ability to perform everyday activities and affect 

    reaction time, balance, sleep patterns and classroom performance.

______  ______ You cannot see a concussion, but you might notice some of the symptoms right   

              away. Other symptoms can show up hours or days after the injury.

______  ______ If I suspect a teammate has a concussion, I am responsible for reporting the 

                injury to my coach.

______  ______ I will not return to play in a game or practice if I have received a blow to the 

    head or body that resulted in concussion-related symptoms.

______  ______ Following a concussion, the brain needs time to heal. You are much more

    likely to have a repeat concussion if you return to play before your symptoms


______  ______ In rare cases, repeat concussions can cause permanent brain damage and

         even death.
I understand and acknowledge the above statements and will notify my coach and parent of any and all symptoms associated with a head injury (diagnosed or potential).  I further agree that I will not continue with athletic participation after a concussion until I am cleared to do so by a physician.I also assume any risk associated with continuing my activity while experiencing post-concussion symptoms. 

Student-Athlete Signature

Student-Athlete Printed Name

Parent Signature

Parent Printed Name