Parent/Player Concussion Information Form
Printable version of the Parent/Player Concussion Information Form English | Spanish
➤Delaware law requires athletes under age 18 and their parents to review and sign annually a Parent/Player Concussion Information Form prior to participation in covered activities sponsored by a club, league or association. Covered activities include football, rugby, soccer, basketball, lacrosse, field or ice hockey, martial or combative sports, wrestling, volleyball, gymnastics, baseball, softball, and cheerleading.
Background
Delaware law requires athletes under age 18 and their parents to review and sign this sheet prior to participation in covered activities sponsored by a club, league or association. Covered activities include football, rugby, soccer, basketball, lacrosse, field or ice hockey, martial or combative sports, wrestling, volleyball, gymnastics, baseball, softball, and cheerleading. This signed form should be given to the sponsoring organization prior to participation, and, for multi-year activities, on a yearly basis.
What is a concussion?
A concussion is a type of traumatic brain injury—or mTBI—caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. A concussion changes how the brain normally works. An athlete does not have to lose consciousness (black out) to get a concussion. A blow elsewhere on the body can cause a concussion even if an athlete does not hit his / her head directly.
Signs and symptoms of a concussion:
Concussions can affect children and teens differently. Below are common symptoms they might report or that might be observed. It can take days for symptoms to appear following the initial hit /fall.
Experienced by Children and Teens
- Headache or “pressure” in the head
- Nausea or Vomiting
- Dizziness or balance problems
- Blurred or double vision
- Light or noise sensitivity
- Ringing in ears
- Difficulty concentrating or remembering
- Confusion
- Feeling slowed down
- Feeling sad, irritable, or more emotional
- Being tired, or a change in sleep
- Just not “feeling right” or “feeling down”
Younger children may not be able to report symptoms, and so decisions should be based on adult observation.
Observed by Parents, Coaches, or Teammates
- Loss of consciousness
- Appears dazed or confused
- Responds slowly / answers questions slowly
- Change in behavior, mood, or personality, including irritability or aggressive
- Can’t recall events prior to or after the hit/fall
- Loses focus on current activities
- Moves clumsily/ Appears off balance
- Slurred speech
- Is more restless or appears more tired than usual
- Change in sleep pattern
What should happen if my child/teen might have a concussion?
The athlete must leave the game, practice or activity immediately. This is Delaware law and is in place to protect your child. They should not re-enter play until seen and evaluated by a licensed medical provider. When in doubt, the athlete sits out. Remember, it is better to miss one game than to miss the whole season. If an athlete continues to play when he or she might have a concussion, there could be serious medical consequences, even death (Second Impact Syndrome). Also, if a concussion has occurred or is suspected the CDC advises that you ask your (child’s/teen’s) health care provider when they can safely return to other activities, e.g. school, drive a car and/or ride a bike.
Athletes should not be left alone. Concussions can have a more serious effect on the young, developing brain-whose development extends into young adulthood. Be aware that sometimes athletes try to hide their symptoms so that they can stay in play. Have your child seen by a physician, even if symptoms resolve. Do not try to judge the severity of the injury yourself.
To return to play:
Delaware law requires that your child be seen and given medical clearance by a licensed medical provider before return to play. Your licensed medical provider may either complete a form or supply a letter certifying clearance. Provide the form or letter to the sponsoring organization. If the licensed medical provider limits school-related activities like classwork, driver’s education, gym and recess, you may wish to share the form or letter with the athlete’s school.
Additional websites:
If you have additional questions regarding concussion or concussion management, we recommend the following websites:
- CDC Headsup Website
Keeping children and teens healthy and safe is always a top priority. Whether you are a parent, youth sports coach, school coach, school professional, or health care provider, this site will help you recognize, respond to, and minimize the risk of concussion or other serious brain injury. - Moms Team Concussion Safety
We first began providing comprehensive concussion safety information to youth sports parents, coaches and athletic trainers in 2000. - Brainline Organization
BrainLine is a national multimedia project offering authoritative information and support to anyone whose life has been affected by brain injury or PTSD: people with brain injuries, their family and friends, and the professionals who work with them.
