Yearly Athlete Registration Form 2018 / 2019
Athlete's Yearly Registration for HOPS for the 2017 / 2018 school year. This form needs to be completed once per school year.
Athlete's First Name *
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Athlete's Last Name *
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Date of Birth *
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YYYY
Gender *
Street Address *
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City *
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State *
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Zip Code *
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Phone Number (please enter in the form xxx-xxx-xxxx) *
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eMail Address *
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Parent / Guardian name *
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Parent / Guardian Phone Number *
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Parent / Guardian Name (2)
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Parent / Guardian Phone Number (2)
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Emergency Contact Name *
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Emergency Contact Phone Number *
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What special needs does your child have?
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Will your child need one to one assistance when playing? *
Please list any medical conditions we need to be aware of
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Consent for rules *
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Type name to confirm consent for rules *
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Consent for photos: *
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Type name to confirm consent for photos *
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Athlete Concussion Fact Sheet
CONCUSSION FACT SHEET FOR ATHLETES | CONCUSSION FACTS: • A concussion is a brain injury that affects how your brain works. • A concussion is caused by a bump, blow, or jolt to the head or body. • A concussion can happen even if you haven’t been knocked out. • If you think you have a concussion, you should not return to play on the day of the injury and until a health care professional says you are OK to return to play. | CONCUSSION SIGNS AND SYMPTOMS: Concussion symptoms differ with each person and with each injury, and may not be noticeable for hours or days. Common symptoms include: • Headache • Confusion • Difficulty remembering or paying attention • Balance problems or dizziness • Feeling sluggish, hazy, foggy, or groggy • Feeling irritable, more emotional, or “down” • Nausea or vomiting • Bothered by light or noise • Double or blurry vision • Slowed reaction time • Sleep problems • Loss of consciousness. During recovery, exercising or activities that involve a lot of concentration (such as studying, working on the computer, or playing video games) may cause concussion symptoms to reappear or get worse. | WHY SHOULD I REPORT MY SYMPTOMS?: • Unlike with some other injuries, playing or practicing with concussion symptoms is dangerous and can lead to a longer recovery and a delay in your return to play. • While your brain is still healing, you are much more likely to have another concussion. • A repeat concussion in a young athlete can result in permanent damage to your brain. They can even be fatal. | WHAT SHOULD I DO IF I THINK I HAVE A CONCUSSION?: DON’T HIDE IT. REPORT IT. Ignoring your symptoms and trying to “tough it out” often makes symptoms worse. Tell your coach, parent, and athletic trainer if you think you or one of your teammates may have a concussion. Don’t let anyone pressure you into continuing to practice or play with a concussion. GET CHECKED OUT. Only a health care professional can tell if you have a concussion and when it’s OK to return to play. Sports have injury timeouts and player substitutions so that you can get checked out and the team can perform at its best. The sooner you get checked out, the sooner you may be able to safely return to play. TAKE CARE OF YOUR BRAIN. A concussion can affect your ability to do schoolwork and other activities. Most athletes with a concussion get better and return to sports, but it is important to rest and give your brain time to heal. A repeat concussion that occurs while your brain is still healing can cause long-term problems that may change your life forever. “IT’S BETTER TO MISS ONE GAME, THAN THE WHOLE SEASON.” | TO LEARN MORE GO TO >> WWW.CDC.GOV/HeadsUp *
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Parent Concussion Fact Sheet
CONCUSSION FACT SHEET FOR PARENTS: WHAT IS A CONCUSSION?: A concussion is a type of traumatic brain injury. Concussions are caused by a bump or blow to the head. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious. You can’t see a concussion. Signs and symptoms of 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. | WHAT ARE THE SIGNS AND SYMPTOMS OF CONCUSSION?: If your child has experienced a bump or blow to the head during a game or practice, look for any of the following signs of a concussion: SYMPTOMS REPORTED BY ATHLETE: • Headache or “pressure” in head • Nausea or vomiting • Balance problems or dizziness • Double or blurry vision • Sensitivity to light • Sensitivity to noise • Feeling sluggish, hazy, foggy, or groggy • Concentration or memory problems • Confusion • Just not “feeling right” or is “feeling down” SIGNS OBSERVED BY PARENTS/ GUARDIANS: • 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 mood, behavior, or personality changes | DANGER SIGNS: Be alert for symptoms that worsen over time. Your child or teen should be seen in an emergency department rightaway if s/he has: • One pupil (the black part in the middle of the eye) larger than the other • Drowsiness or cannot be awakened • A headache that gets worse and does not go away • Weakness, numbness, or decreased coordination • Repeated vomiting or nausea • Slurred speech • Convulsions or seizures • Difficulty recognizing people or places • Increasing confusion, restlessness, or agitation • Unusual behavior • Loss of consciousness (even a brief loss of consciousness should be taken seriously) | WHAT SHOULD YOU DO IF YOU THINKYOUR 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 regular activities, including sports. 2. KEEP YOUR CHILD OUT OF PLAY. Concussions take time to heal. Don’t let your child return to play the day of the injury and until a healthcare 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. Repeat 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 ABOUTANY PREVIOUS CONCUSSION. Coaches should know if your child had a previous concussion. Your child’s coach may not know about a concussion your child received in another sport or activity unless you tell the coach. | HOW CAN YOU HELP YOUR CHILD PREVENT A CONCUSSION OR OTHER SERIOUS BRAIN INJURY?: • 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. Protective equipment should fit properly and be well maintained. • Wearing a helmet is a must to reduce the risk of a serious brain injury or skull fracture. • However, helmets are not designed to prevent concussions. There is no “concussion-proof” helmet. So, even with a helmet, it is important for kids and teens to avoid hits to the head. | HOW CAN I HELP MY CHILD RETURN TO SCHOOL SAFELY AFTER A CONCUSSION?: Children and teens who return to school after a concussion may need to: • Take rest breaks as needed • Spend fewer hours at school • Be given more time to take tests or complete assignments • Receive help with schoolwork • Reduce time spent reading, writing, or on the computer. Talk with your child’s teachers, school nurse, coach, speech-language pathologist, or counselor about your child’s concussion and symptoms. As your child’s symptoms decrease, the extra help or support can be removed gradually. | TO LEARN MORE GO TO >> WWW.CDC.GOV/HeadsUp *
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Concussion Action Plan
HEADS UP CONCUSSION ACTION PLAN | IF YOU SUSPECT THAT AN ATHLETE HAS A CONCUSSION, YOU SHOULD TAKE TAKE THE FOLLOWING STEPS: 1. Remove the athlete from play. 2. Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion. Do not try to judge the seriousness of the injury yourself. 3. Inform the athlete’s parents or guardians about the possible concussion and give them the fact sheet on concussion. 4. Keep the athlete out of play the day of the injury. An athlete should only return to play with permission from a health care professional, who is experienced in evaluating for concussion. | CONCUSSION SIGNS AND SYMPTOMS: Athletes who experience one or more of the signs and symptoms listed below after a bump, blow, or jolt to the head or body may have a concussion. SYMPTOMS REPORTED BY ATHLETE • Headache or “pressure” in head • Nausea or vomiting • Balance problems or dizziness • Double or blurry vision • Sensitivity to light • Sensitivity to noise • Feeling sluggish, hazy, foggy, or groggy • Concentration or memory problems • Confusion • Just not “feeling right” or is “feeling down” SIGNS OBSERVED BY COACHING STAFF: • 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 mood, behavior, or personality changes • Can’t recall events prior to hit or fall | TO LEARN MORE GO TO >> WWW.CDC.GOV/HeadsUp *
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Please enter you name to confirm you have read, understand and will comply with the concussion fact sheets in this form *
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