Richfield Rockets Concussion Information - 2020 Season
Please read the concussion information below, and when finished, please enter your name (name of parent) and name of player(s) from your family participating in Rockets baseball at the end of this form.  Thank you!  

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Concussion Information - When in Doubt, Sit Them Out!
 
1. Before a student may participate in practice or competition:  At the beginning of a season for a youth athletic activity, the person operating the youth athletic activity shall distribute a concussion and head injury information sheet to each person who will be coaching that youth athletic activity and to each person who wishes to participate in that youth athletic activity. No person may participate in a youth athletic activity unless the person returns the information sheet signed by the person and, if he or she is under the age of 19, by his or her parent or guardian.
2. An athletic coach, or official involved in a youth athletic activity, or health care provider shall remove a person from the youth athletic activity if the coach, official, or health care provider determines that the person exhibits signs, symptoms, or behavior consistent with a concussion or head injury or the coach, official, or health care provider suspects the person has sustained a concussion or head injury.
3. A person who has been removed from a youth athletic activity may not participate in a youth athletic activity until he or she is evaluated by a health care provider and receives a written clearance to participate in the activity from the health care provider.

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These are some SIGNS concussion (what others can see in an injured athlete):
Dazed or stunned appearance
Change in the level of consciousness or awareness
Confused about assignment
Forgets plays
Unsure of score, game, opponent
Clumsy
Answers more slowly than usual
Shows behavior changes
Loss of consciousness
Asks repetitive questions or memory concerns

These are some of the more common SYMPTOMS of concussion (what an injured athlete feels):
Headache
Nausea
Dizzy or unsteady
Sensitive to light or noise
Feeling mentally foggy
Problems with concentration and memory
Confused
Slow

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Injured athletes can exhibit many or just a few of the signs and/or symptoms of concussion. However, if a player exhibits any signs or symptoms of concussion, the responsibility is simple: remove them from participation. “When in doubt sit them out.”

It is important to notify a parent or guardian when an athlete is thought to have a concussion. Any athlete with a concussion must be seen by an appropriate health care provider before returning to practice (including weight lifting) or competition.

RETURN TO PLAY

Current recommendations are for a controlled progressive return to play program following removal from play. In order to resume activity, the athlete must be symptom free and off any pain control or headache medications. The athlete should be unrestricted in academic activity without any significant accommodations. Finally, the athlete must have clearance from an appropriate health care provider.

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2011 WISCONSIN ACT 172
Date of enactment: April 2, 2012
(Abbreviated from Legislative Act)
In this section:
(a) "Credential" means a license or certificate of certification issued by this state.
(b) "Health care provider" means a person to whom all of the following apply:
1. He or she holds a credential that authorizes the person to provide health care.
2. He or she is trained and has experience in evaluating and managing pediatric concussions
and head injuries.
3. He or she is practicing within the scope of his or her credential.
(c) "Youth athletic activity" means an organized athletic activity in which the participants, a majority of whom are under 19 years of age, are engaged in an athletic game or competition against another team, club, or entity, or in practice or preparation for an organized athletic game or competition against another team, club, or entity. "Youth athletic activity" does not include a college or university activity or an activity that is incidental to a nonathletic program.

In consultation with the Wisconsin Interscholastic Athletic Association, the department shall develop guidelines and other information for the purpose of educating athletic coaches and pupil athletes and their parents or guardians about the nature and risk of concussion and head injury in youth athletic activities.

At the beginning of a season for a youth athletic activity, the person operating the youth athletic activity shall distribute a concussion and head injury information sheet to each person who will be coaching that youth athletic activity and to each person who wishes to participate in that youth athletic activity. No person may participate in a youth athletic activity unless the person returns the information sheet signed by the person and, if he or she is under the age of 19, by his or her parent or guardian.

An athletic coach, or official involved in a youth athletic activity, or health care provider shall remove a person from the youth athletic activity if the coach, official, or health care provider determines that the person exhibits signs, symptoms, or behavior consistent with a concussion or head injury or the coach, official, or health care provider suspects the person has sustained a concussion or head injury.   A person who has been removed from a youth athletic activity may not participate in a youth athletic activity until he or she is evaluated by a health care provider and receives a written clearance to participate in the activity from the health care provider.

Any athletic coach, official involved in an athletic activity, or volunteer who fails to remove a person from a youth athletic activity under the Wisconsin Concussion Law is immune from civil liability for any injury resulting from that omission unless it constitutes gross negligence or willful or wanton misconduct.  Any volunteer who authorizes a person to participate in a youth athletic activity the Wisconsin Concussion Law is immune from civil liability for any injury resulting from that act unless the act constitutes gross negligence or willful or wanton misconduct.

This section does not create any liability for, or a cause of action against, any person. 

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Richfield Rockets Baseball Program


Statement Acknowledging Receipt of Education and Responsibility to report signs or symptoms of concussion to be included as part of the “Participant and Parental Disclosure and Consent Document”.

FOR PLAYERS:
As an athlete participating in the Richfield Rockets Baseball Program, I hereby acknowledge having received education about the signs, symptoms, and risks of sport related concussion. I also acknowledge my responsibility to report to my coaches, parent(s)/guardian(s) any signs or symptoms of a concussion.

FOR PARENTS:
I, the parent/guardian of an athlete participating in the Richfield Rockets Baseball Program, hereby acknowledge having received education about the signs, symptoms, and risks of sport related concussion.

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Parent Name: *
Player's Name (if multiple players in the family, list them all): *
What team does your OLDEST son play on? *
Have all parents and players listed on this form read and understand the information provided above about sport-related concussions? *
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