By its nature, participation in Interscholastic Athletics includes risk of injury, which range in severity from minor to disabling to even death. Although serious injuries are not common in supervised school athletic programs, it is impossible to eliminate all risk. Participants can and do have the responsibility to help reduce the chance of injury. Players must obey all safety rules, report all physical problems to their coaches, follow a proper conditioning program, and inspect their own equipment daily.

By signing this permission form, we acknowledge that we have read the above information. PARENTS OR STUDENTS WHO DO NOT

WISH TO ACCEPT THE RISK DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS PERMISSION FORM.

1. Represent Cornerstone Christian Academy in approved athletic activities except those that are restricted by a medical doctor.
2. To accompany any school team of which he/she is a member of its local or out-of-town trips.
3. To receive through a doctor od CCA's choice, emergency medical care which may become reasonably necessary in the course of such athletic events or such travel."

I have read the foregoing and will abide by the principles and regulations contained herein.

Cornerstone Christian Academy uses photographs, videos, or illustrations of students for many purposes such as newslettersor publications by CCA, or in video presentations about CCA. This form allows you, as a parent or guardian, to choose whether your child may be in a video, photograph or other illustration used by Cornerstone Christian Academy.

What is a concussion? A concussion is an injury to the brain caused by a direct or indirect blow to the head. It results in your brain not working as it should. It may or may not cause you to black out or pass out. It can happen to you from a fall, a hit to the head, or a hit to the body that causes your head and your brain to move quickly back and

How do I know if I have a concussion? There are many signs and symptoms that you may have following a concussion. A concussion can affect your thinking, the way your body feels, your mood, or your sleep. Here is what to look for:

Thinking/Remembering

Difficulty thinking clearly
Taking longer to figure things out
Difficulty concentrating
Difficulty remembering new information

Physical

Headache
Fuzzy or blurry vision
Feeling sick to your stomach/queasy
Vomiting/throwing up
Dizziness
Balance problems
Sensitivity to noise or light

Emotional/Mood

Irritability-things bother you more easily
Sadness
Being more moody
Feeling nervous or worried
Crying more

Sleep

Sleeping more than usual
Sleeping less than usual
Trouble falling asleep
Feeling tired

Table is adapted from the Centers for Disease Control and Prevention (http://www.cdc.gov/concussion/)

What should I do if I think I have a concussion? If you are having any of the signs or symptoms listed above, you should tell your parents, coach, athletic trainer or school nurse so they can get you the help you need. If a parent notices these symptoms, they should inform the school nurse or athletic trainer.

When should I be particularly concerned? If you have a headache that gets worse over time, you are unable to control your body, you throw up repeatedly or feel more and more sick to your stomach, or your words are coming out funny/slurred, you should let an adult like your parent or coach or teacher know right away, so they can get you the help you need before things get any worse.

What are some of the problems that may affect me after a concussion? You may have trouble in some of your classes at school or even with activities at home. If you continue to play or return to play too early with a concussion, you may have long term trouble remembering things or paying attention, headaches may last a long time, or personality changes can occur Once you have a concussion, you are more likely to have another concussion.

How do I know when it's ok to return to physical activity and my sport after a concussion? After telling your coach, your parents, and any medical personnel around that you think you have a concussion, you will probably be seen by a doctor trained in helping people with concussions. Your school and your parents can help you decide who is best to treat you and help to make the decision on when you should return to activity/play or practice. Your school will have a policy in place for how to treat concussions. You should not return to play or practice on the same day as your suspected concussion.

This information is provided to you by the UNC Matthew Gfeller Sport-Related TBI Research Center, North Carolina Medical Society, North Carolina Athletic Trainers' Association, Brain Injury Association of North Carolina, North Carolina Neuropsychological Society, and North Carolina High School Athletic Association.

Gfeller-Waller NCHSAA Student-Athlete & Parent/Legal Custodian Concussion Information Sheet

You should not have any symptoms at rest or during/after activity when you return to play, as this is a sign your brain has not recovered from the injury.

Instructions: The student athlete and his/her parent or legal custodian, must initial beside each statement acknowledging that they have read and understand the corresponding statement. The student-athlete should initial in the left column and the parent or legal custodian should initial in the right column. Some statements are applicable only to the student-athlete and should only be initialed by the student-athlete. This form must be completed for each student-athlete, even if there are multiple student-athletes in the household.

A concussion is a brain injury, which should be reported to my parent(s) or legal custodian(s), my or my child's coach(es), or a medical professional if one is available.

A concussion cannot be "seen." Some signs and symptoms might be present immediately; however, other symptoms can appear hours or days after an injury.

I will tell my parents, my coach and/or a medical professional about my injuries and illnesses

 

If I think a teammate has a concussion, I should tell my coach(es), parent(s)/ legal custodian(s) or medical professional about the concussion.

I or my child will not return to play in a game or practice if a hit to my or my childs head or body causes any concussion related symptoms

I or my child will need written permission from a medical professional trained in concussion management to return to play or practice after a concussion.

Based on the latest data, most concussions take days or weeks to get better. A concussion may not go away, right away. I realize that resolution from a concussion is a process that may require more than one medical visit.

I realize that ER/Urgent Care physicians will not provide clearance to return to play or practice, if seen immediately or shortly after the injury.

After a concussion, the brain needs time to heal. I understand that I or my child is much more likely to have another concussion or more serious brain injury if return to play or practice occurs before concussion symptoms go away.

Sometimes repeat concussions can cause serious and longlasting problems.

I have read the concussion symptoms listed on the Student-Athlete/ Parent Legal Custodian Concussion Information Sheet.

I have asked an adult and/or medical professional to explain any information contained in the Student-Athlete & Parent Concussion Statement Form or Information Sheet.

By signing below, we agree that we have read and understand the information contained in the Student/Athlete Parent/Legal Custodian Concussion Statement Form, and have initialed appropriately beside each statement.

I have read the foregoing and will abide by the principles and regulations contained herein.

This Liability Waiver Form must be completed, and signed by the parent or guardian for each student athlete (including cheerleaders) before participation in any NCCSA athletic game, activity, contest or event.

The original must be on file in the school office.

FOR AND IN CONSIDERATION OF the mutual promises, covenants, conditions, representations, and warranties contained herein, and for other good and valuable consideration, the receipt and legal sufficiency of which are hereby acknowledged, it is agreed as follows:

The undersigned hereby releases and forever discharges the North Carolina Christian School Association (NCCSA) along with all of its agents, employees, directors, officers, assigns, and attorneys, from any and all claims, demands, actions, causes of action or suits arising out of any injuries, known or unknown, which have resulted or may in the future result from any NCCSA sponsored athletic game, activity, contest or event that takes place at any location approved by the North Carolina Christian School Association

The undersigned hereby assumes all risk of injury associated with any such athletic game, activity, contest or event and fully indemnifies and holds harmless the NCCSA along with its agents, employees, directors, officers, assigns, and attorneys, from and against each and every liability, loss, cost, damage, and expense, including attorney's fees, which the NCCSA along with its agents, employees, directors, officers, assigns, and attorneys may incur as a result of any NCCSA sponsored athletic game, activity, contest or event that takes place at any location approved by the North Carolina Christian School Association.

This liability waiver/release applies to the following student athlete:

who is currently enrolled in the following NCCSA member school:

School Name: Cornerstone Christian Academy

School Address:3000 Scotty Hill Road, Fayetteville NC 28303

Notice to sponsoring school: A parent or guardian of the named student athlete in NCCSA sponsored competitions must sign this document before such student can participate in any NCCSA sponsored event.

Click Here to Download the Physical Form for Your Doctor.