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WEST SIDE ALLIANCE

SOCCER CLUB

CONCUSSION WAIVER & AGREEMENT

WEST SIDE ALLIANCE S.C. CONCUSSION INFORMATION and WAIVER 

All West Side Alliance S.C. athletes and parents must read and acknowledge this waiver before the start of the season to be permitted to participate in WSA activities. BY CHECKING THE BOX BELOW WE UNDERSTAND AND AGREE AS FOLLOWS:
 

1.     As a player I understand that it is my responsibility to report all injuries to my coach to let him or her know of any precautions they must take. If at all possible, I will undergo a baseline concussion test prior to the start of the season. 
 

2.     I understand that a concussion is a Traumatic Brain Injury and the effects and implications of any such injury are severe. Some symptoms of a concussion are forgetfulness, nausea, dizziness, headache or pressure, blurry vision, clumsiness, and confusion. For severe concussions, loss of consciousness may occur. 
 

3.     A concussion may affect my ability to perform everyday tasks and may affect reaction time, sleep patterns, balance, and cognitive performance. For more information on concussion symptoms visit the WSA Website Player and Parent Resource section. 
 

4.     A concussion can have symptoms that appear immediately after the injury, or, sometimes don’t appear until a few hours or a few days later.  Therefore all head injuries or suspected head injuries should be treated with caution.  A player who has had any kind of head trauma must be monitored by a health care professional, who will check their symptom picture that day, and the following 48 hours after the event. In rare cases, repeat concussions can cause permanent brain damage and even death. 
 

5.     As a player, I understand it is my responsibility to report any symptoms or problems to my coach and / or parents in a timely manner. 
 

6.     I will not return to play in a game or practice if I have received a blow to the head that has resulted in concussion-related symptoms. I understand that this is a precautionary measure to prevent any further injury until a proper diagnosis is received by a qualified medical professional. 
 

7.     If I am experiencing concussion-related symptoms or if my coach or an on site trainer, observes concussion related symptoms, I must seek medical attention from a qualified professional before I will be allowed to return to play. Physical and mental rest is the only treatment for concussions and even mild concussions require at least a week of rest to fully heal. The CDC recommends a gradual 6-step progression back into sport participation, which should be implemented and monitored by a medical professional. The 6-step return to play progression is outlined on the WSA Website under Player & Parent Resources.  Players diagnosed with a concussion must get cleared by a medical professional trained and experienced in diagnosing and treating concussions before being allowed to return to physical activity. Written confirmation of this clearance must be provided to WSA.
 

8.     WSA is not responsible for the failure of players to report concussion symptoms.  By signing below the player and their representatives waive and hold harmless WSA for any aggravation of an undisclosed concussion.

 By clicking the box below, I the undersigned confirm that I have reviewed the information regarding concussions outlined in this document and agree to the document’s protocol concerning concussion treatment: