DeForest Area Youth Football League

Concussion Management Plan

As a parent and as an athlete, it is important to recognize the signs, symptoms, and behaviors of concussions. By accepting this form you are stating that you understand the importance of recognizing and responding to the signs, symptoms, and behaviors of a concussion or head injury and certify that you have read, understand, and agree to abide by all of the information below. You further certify that if you have not understood any information contained below, you have sought and received an explanation of the information prior to signing off on this waiver.

Parent Agreement:

I hereby acknowledge having been provided with education through the “Heads Up Fact Sheet for Parents/Players” posted on the Deforest Youth Football website (https://www.deforestyouthfootball.info/) under “Parents & Players/Concussion Management” (https://www.deforestyouthfootball.info/Default.aspx?tabid=883116)

I have read the “Heads Up Fact Sheet for Parents/Players” and understand what a concussion is and how it may be caused. I also understand the common signs, symptoms, and behaviors. I agree that my child must be removed from practice/play if a concussion is suspected.

I understand that it is my responsibility to seek medical treatment if a suspected concussion is reported to me.

I understand that my child cannot return practice/play until providing written clearance from an appropriate health care provider to his/her coach.

I understand the possible consequences of my child returning to practice/play too soon.

Athlete Agreement:

I hereby acknowledge having been provided with education through the “Heads Up Fact Sheet for Parents/Players” posted on the Deforest Youth Football website (https://www.deforestyouthfootball.info/) under “Parents & Players/Concussion Management” (https://www.deforestyouthfootball.info/Default.aspx?tabid=883116)

I have read the “Heads Up Fact Sheet for Parents/Players” and understand what a concussion is and how it may be caused.

I understand the importance of reporting a suspected concussion to my coaches and my parents/guardian.

I understand that I must be removed from practice/play if a concussion is suspected. I understand that I must provide written clearance from an appropriate health care provider to my coach before returning to practice/play.

I understand the possible consequences of returning to practice/play too soon and that my brain needs time to heal.