IICL Concussion Protocol Understanding and Acknowledgement
This form has information to help you protect yourself or others from concussion or other serious brain injury and know what to do if a concussion occurs.
This form also provides the acknowledgment that you have received education on concussions and the IICL specific concussion protocol.
Parents and student-athletes should complete this form together.
A concussion is a brain injury that affects how your brain works. It can happen when your brain gets bounced around in your skull after a fall or hit to the head. *
Required
If you think you have a concussion, do not return to play on the day of the injury. Only a healthcare provider can tell whether you have a concussion and when it is OK to return to school and play. The sooner you get checked out, the sooner you may be able to safely return to play. *
Required
Tell your coach, parent, and athletic trainer if you think you or one of your teammates may have a concussion. It’s up to you to report your symptoms. Your coach and team are relying on you. Plus, you won’t play your best if you are not feeling well. *
Required
A concussion can make everyday activities, such as going to school, harder. You may need extra help getting back to your normal activities. Be sure to update your parents and doctor about how you are feeling. *
Required
Playing or practicing with a concussion is dangerous and can lead to a longer recovery. *
Required
While your brain is still healing, you are much more likely to have another concussion. This can put you at risk for a more serious injury to your brain and can even be fatal. *
Required
You may have a concussion if you have any of these symptoms after a bump, blow, or jolt to the head or body (check each one to confirm understanding): *
Required
Concussion symptoms don’t always show up right away, sometimes they can show up in the minutes after an event but it is not uncommon for them to show up in the hours and up to a day afterward *
Required
Next
Never submit passwords through Google Forms.
This form was created inside of National Interscholastic Cycling Association. Report Abuse - Terms of Service