Entiat Youth Basketball 

Please fill out a separate form for each child

 

MEDICAL RELEASE

Player Name has my permission to participate in the Entiat AAU Youth
Basketball program. I the undersigned, parent/guardian, assume all risks and hazards incidental to participating in
this activity and do hereby authorize the identified representative of the Entiat AAU program to obtain such
medical diagnostic services as may be deemed necessary. Emergency treatment of a life-threatening condition is
authorized. Telephone contact for management of all serious conditions will be attempted if possible.

 

CONCUSSION FACT SHEET

A concussion is a brain injury that is caused by a bump or blow to the head. It can change the way your brain normally works. It can
occur during practices or games in any sport. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the
head can be serious. A concussion can happen even if you haven't been knocked out. You can’t see a concussion. Signs and
symptoms of a concussion can show up right after the injury or may not appear or be noticed until days or weeks after the injury. If
your child reports any symptoms of concussion, or if you notice the symptoms yourself, seek medical attention right away.

PARENTS AND GUARDIANS
What are the signs and symptoms of a concussion observed
by Parents/Guardians:
If your child has experienced a bump or blow to the head during
a game or practice, look for any of the following signs and
symptoms of a concussion:
 Appears dazed or stunned
 Is confused about assignment or position
 Forgets an instruction
 Is unsure of game, score, or opponent
 Moves clumsily
 Answers questions slowly
 Loses consciousness (even briefly)
 Shows behavior or personality changes
 Can’t recall events prior to being hit or falling
 Can’t recall events after being hit or falling
How can a Parent/Guardian help their child prevent a
concussion?
Every sport is different, but there are steps your children can take
to protect themselves from concussion.
 Ensure that they follow their coach’s rules for safety and the
rules of the sport.
 Encourage them to practice good sportsmanship at all times.
 Make sure they wear the right protective equipment for their
activity (such as helmets, padding, shin guards, and eye and
mouth guards). Protective equipment should fit properly, be
well maintained, and be worn consistently and correctly.
 Learn the signs and symptoms of a concussion.

What should a Parent/Guardian do if they think their child
has a concussion?
1. Seek medical attention right away. A health care
professional will be able to decide how serious the
concussion is and when it is safe for your child to return to
sports. Notify your child's coach if you think your child has
a concussion.
2. Keep your child out of play. Concussions take time to heal.
Don’t let your child return to play until a health care
professional says it’s OK. Children who return to play too
soon—while the brain is still healing—risk a greater chance
of having a second concussion. Second or later concussions
can be very serious. They can cause permanent brain
damage, affecting your child for a lifetime.
3. Tell your child’s coach about any recent concussion in ANY
sport or activity. Your child’s coach may not know about a
concussion your child received in another sport or activity
unless you tell the coach.

ATHLETES
What are the symptoms of a concussion?
 Headache or “pressure” in head
 Nausea or vomiting
 Balance problems or dizziness
 Double or blurry vision
 Bothered by light
 Bothered by noise
 Feeling sluggish, hazy, foggy, or groggy
 Difficulty paying attention
 Memory problems
 Confusion
 Does not “feel right”
What should an athlete do if they think they have a
concussion?
 Tell your coaches and your parents. Never ignore a
bump or blow to the head even if you feel fine. Also, tell
your coach if one of your teammates might have a
concussion.
 Get a medical check up. A doctor or health care
professional can tell you if you have a concussion and
when you are OK to return to play.
 Give yourself time to get better. If you have had a
concussion, your brain needs time to heal. While your brain
is still healing, you are much more likely to have a second
concussion. Second or later concussions can cause damage
to your brain. It is important to rest until you get approval
from a doctor or health care professional to return to play.
 It is better to miss one game than the whole season.
How can athletes prevent a concussion?
Every sport is different, but there are steps you can take to
protect yourself.
 Follow your coach’s rules for safety and the rules of the
sport.
 Practice good sportsmanship at all times.
 Use the proper sports equipment, including personal
protective equipment (such as helmets, padding, shin
guards, and eye and mouth guards). In order for equipment
to protect you, it must be:
o The right equipment for the game, position, or
activity
o Worn correctly and fit well
o Used every time you play
o Repaired and maintained

DO NOT E-SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT. By my eSignature below, I certify that I have read, fully understand and accept all terms of the foregoing statement. Please signify your acceptance by entering your full name in the box below