The following form must be filled out on Athletic Trainer System (ATS)

Once logged in to the Athletic Trainer System (ATS) portal, click on "Athlete Information" and then click on the "Forms" tab. On the drop down menu, find "Injury Concussion Acknowledgment Consent and then click "New." Both athlete and parent must read and electronically sign the document and save to your ATS account. Click here to access ATS: Athletic Trainer System Portal

 

Injury & Concussion acknowledgment

Please answer the following statements with a "yes" to indicate your understanding and consent.

Q1: I understand that it is my responsibility to report all injuries and illnesses to my athletic trainer.

I have read through the Injury and Concussion CDC educational material, which is always available on the JP Athletics site (under “forms & links”).

 A1: Yes

Q2: I understand how to get in touch with the JP Athletic trainer in person, by email/phone, and/or by using this ATS portal.

 A2: Yes

After reading the Injury & Concussion care presentation and the CDC concussion fact sheet, I am aware of the following information:

Q3: A concussion is a brain injury that I am responsible for reporting to my athletic trainer, coach, and parents. It is especially important if a physician gets involved to be prompt with providing updates.

 A3: Yes

Q4: A concussion can affect everyday activities, school work & activities, athletic performance, balance, sleep, reaction time, and other brain functions.

 A4: Yes

Q5: If I suspect a teammate has a concussion I am responsible for raising the concern with my coach, and/or my athletic trainer.

 A5: Yes

Q6: I will not return to activity on the same day if I have received a blow to the head or body that results in concussion related symptoms.

 A6: Yes

Q7: Following a concussion the brain needs time to heal. A person, especially an adolescent, is much more likely to have complications, another concussion or worse injury if a return to play happens before healing/ resolution occurs.

 A7: Yes

Q8: I understand that in rare cases, repeated concussions can cause permanent brain damage or even death.

 A8: Yes

Q9: I understand that completion of Return-to-Play Protocol, physician clearance and athletic trainer clearance must occur before an athlete returns to participation. The concussion return to play protocol also includes parental opinion input in writing.

 A9: Yes


https://johnpaulathletics.org