Concussion Code of Conduct – Player/Parent

Player *

First

Last

Parent *

First

Last

I will help prevent concussions by: wearing the proper equipment for my sport and wearing it correctly, developing my skills and strength so that I can participate to the best of my ability, respecting the rules of my sport or activity and following my commitment to fair play and respect for all (respecting other athletes, coaches, team trainers and officials). *

Yes
No

I will care for my health and safety by taking concussions seriously, and I understand that: a concussion is a brain injury that can have both short- and long-term effects, a blow to my head, face or neck, or a blow to the body that causes the brain to move around inside the skull may cause a concussion, I don’t need to lose consciousness to have had a concussion, I have a commitment to concussion recognition and reporting, including self-reporting of possible concussion and reporting to a designated person when an individual suspects that another participant may have sustained a concussion. (Meaning: If I think I might have a concussion I should stop participating in further training, practice or competition immediately. I will tell an adult if I think another athlete has a concussion) and continuing to participate in further training, practice or competition with a possible concussion increases my risk of more severe, longer lasting symptoms, and increases my risk of other injuries. *

Yes
No

I will not hide concussion symptoms. I will speak up for myself and others: I will not hide my symptoms. I will tell a coach, official, team trainer, parent or another adult I trust if I experience any symptoms of concussion, if someone else tells me about concussion symptoms, or I see signs they might have a concussion, I will tell a coach, official, team trainer, parent or another adult I trust so they can help, I understand that if I have a suspected concussion, I will be removed from sport and that I will not be able to return to training, practice or competition until I undergo a medical assessment by a medical doctor or nurse practitioner and have been medically cleared to return to training, practice or competition and I have a commitment to sharing any pertinent information regarding incidents of removal from sport with the athlete’s school and any other sport organization with which the athlete has registered* (Meaning: If I am diagnosed with a concussion, I understand that letting all of my other coaches and teachers know about my injury will help them support me while I recover.) *

Yes
No

I will take the time I need to recover, because it is important for my health. I understand my commitment to supporting the return-to-sport process (I will have to follow my sport organization’s Return-to-Sport Protocol). I understand I will have to be medically cleared by a medical doctor or nurse practitioner before returning to training, practice or competition. I will respect my coaches, team trainers, parents, health-care professionals, and medical doctors and nurse practitioners, regarding my health and safety. *

Yes
No

Date / Time

By providing my email as an Electronic Signature here, I acknowledge that I have fully reviewed and commit to this Concussion Code of Conduct.as a Player *

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By providing my email as an Electronic Signature here, I acknowledge that I have fully reviewed and commit to this Concussion Code of Conduct as a Parent's(s') or Legal Guardian's(s')

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