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

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Gfeller-Waller NCHSAA Student-Athlete & Parent/Legal Custodian Concussion Statement Form

  • 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 child’s, 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 long-lasting 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 that I do not understand.
  • By signing below, we agree that we have read and understand the information contained in the StudentAthlete & Parent/Legal Custodian Concussion Statement Form, and have initialed appropriately beside each statement.

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