Forms

Click for the NEW IHSAA ANNUAL SPORTS PHYSICAL FORM for 2017-2018.

Read the information below for the Sudden Cardiac and Concussion Forms. Sorry it is lengthy, but it is important and legally required.


Heads Up Concussion and Sudden Cardiac Arrest - Student and Parent Info and Forms

Laws IC 20-34-7 and IC 20-34-8 require schools to distribute information sheets to inform and educate student athletes and their parents on the nature and risk of concussion, head injury and sudden cardiac arrest to student athletes, including the risks of continuing to play after concussion or head injury.

These laws require that each year, before beginning practice for an interscholastic or intramural sport, a student athlete and the student athlete’s parents must be given an information sheet, and both must sign and return a form acknowledging receipt of the information to the student athlete’s coach.

IC 20-34-7 states that a high school athlete who is suspected of sustaining a concussion or head injury in a practice or game, shall be removed from play at the time of injury and may not return to play until the student athlete has received a written clearance from a licensed health care provider trained in the evaluation and management of concussions and head injuries.

IC 20-34-8 states that a student athlete who is suspected of experiencing symptoms of sudden cardiac arrest shall be removed from play and may not return to play until the coach has received verbal permission from a parent or legal guardian of the student athlete to return to play. Within 24 hours, this verbal permission must be replaced by a written statement from the parent or guardian.

1. Read the Information below in the tabs: "Students" or "Parents" regarding Concussion and Sudden Cardiac Arrest and then fill out and submit the form at the bottom of the reading material.

2. Students must submit the Student Acknowledgement Form and Parents (just 1 parent per athlete) the Parent Acknowledgement form annually. DO NOT FILL OUT THE STUDENT FORM UNLESS YOU ARE THE STUDENT ATHLETE.

Click the tab to reveal forms and info

STUDENTS

SUDDEN CARDIAC ARREST - STUDENT INFO

FACTS

Sudden cardiac arrest can occur even in athletes who are in peak shape. Approximately 500 deaths are attributed to sudden cardiac arrest in athletes each year in the United States. Sudden cardiac arrest can affect all levels of athletes, in all sports, and in all age levels. The majority of cardiac arrests are due to congenital (inherited) heart defects. However, sudden cardiac arrest can also occur after a person experiences an illness which has caused an inflammation to the heart or after a direct blow to the chest. Once a cardiac arrest occurs, there is very little time to save the athlete, so identifying those at risk before the arrest occurs is a key factor in prevention.

WARNING SIGNS

There may not be any noticeable symptoms before a person experiences loss of consciousness and a full cardiac arrest (no pulse and no breathing).

Warning signs can include a complaint of:

  • Chest Discomfort
  • Unusual Shortness of Breath
  • Racing or Irregular Heartbeat
  • Fainting or Passing Out

EMERGENCY SIGNS – Call EMS (911)

If a person experiences any of the following signs, call EMS (911) immediately:

  • If an athlete collapses suddenly during competition
  • If a blow to the chest from a ball, puck or another player precedes an athlete’s complaints of any of the warning signs of sudden cardiac arrest
  • If an athlete does not look or feel right and you are just not sure

How can I help prevent a sudden cardiac arrest?

Daily physical activity, proper nutrition, and adequate sleep are all important aspects of lifelong health. Additionally, you can assist by:

  • Knowing if you have a family history of sudden cardiac arrest (onset of heart disease in a family member before the age of 50 or a sudden, unexplained death at an early age)
  • Telling your health care provider during your pre-season physical about any unusual symptoms of chest discomfort, shortness of breath, racing or irregular heartbeat, or feeling faint, especially if you feel these symptoms with physical activity
  • Taking only prescription drugs that are prescribed to you by your health care provider
  • Being aware that the inappropriate use of prescription medications or energy drinks can increase your risk
  • Being honest and reporting symptoms of chest discomfort, unusual shortness of breath, racing or irregular heartbeat, or feeling faint

What should I do if I think I am developing warning signs that may lead to sudden cardiac arrest?

  1. Tell an adult – your parent or guardian, your coach, your athletic trainer or your school nurse
  2. Get checked out by your health care provider
  3. Take care of your heart
  4. Remember that the most dangerous thing you can do is to do nothing

Developed and Reviewed by the Indiana Department of Education’s Sudden Cardiac Arrest Advisory Board (1-7-15)

HEADS UP CONCUSSION FOR STUDENT

What is a concussion?

  • A concussion is a brain injury that:
  • Is caused by a bump, blow, or jolt to the head or body.
  • Can change the way your brain normally works.
  • Can occur during practices or games in any sport or recreational activity.
  • Can happen even if you haven’t been knocked out.
  • Can be serious even if you’ve just been “dinged” or “had your bell rung.”

All concussions are serious. A concussion can affect your ability to do schoolwork and other activities (such as playing video games, working on a computer,studying, driving, or exercising). Most people with a concussion get better, but it is important to give your brain time to heal.

What are the symptoms of a concussion?

You can’t see a concussion, but you might notice one or more of the symptoms listed below or that you“don’t feel right” soon after, a few days after, or even weeks after the injury.

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Bothered by light or noise
  • Feeling sluggish, hazy, foggy or groggy
  • Difficulty paying attention
  • Memory problems
  • Confusion

What should I do if I think I have a concussion?

Tell your coaches and your parents.Never ignore a bump or blow to the head even if you feel fine. Also,tell your coach right away if you think you have a concussion or if one of your teammates might have a concussion.

  • Get a medical check-up. A doctor or other healthcare professional can tell if you have a concussion and when it is OK to return to play.
  • Give yourself time to get better. If you have a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have another concussion. Repeat concussions can increase the time it takes for you to recover and may cause more damage to your brain. It is important to rest and not return to play until you get the OK from your health care professional that you are symptom-free.

How can I prevent a concussion?

Every sport is different, but there are steps you can take to protect yourself.

  • Use the proper sports equipment, including personal protective equipment. In order for equipment to protect you, it must be:
    • The right equipment for the game, position, or activity
    • Worn correctly and the correct size and fit
    • Used every time you play or practice
  • Follow your coach’s rules for safety and the rules of the sport.
  • Practice good sportsmanship at all times.

If you think you have a concussion:

Don’t hide it. Report it. Take time to recover.

It’s better to miss one game than the whole season.

For more information and to order additional materials free-of-charge, visit: www.cdc.gov/Concussion.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION

STUDENT ATHLETE FORM

PARENTS

SUDDEN CARDIAC ARREST FACTS FOR PARENTS

FACTS

Sudden cardiac arrest is a rare, but tragic event that claims the lives of approximately 500 athletes each year in the United States. Sudden cardiac arrest can affect all levels of athletes, in all sports, and in all age levels. The majority of cardiac arrests are due to congenital (inherited) heart defects. However, sudden cardiac arrest can also occur after a person experiences an illness which has caused an inflammation to the heart or after a direct blow to the chest.

WARNING SIGNS

There may not be any noticeable symptoms before a person experiences loss of consciousness and a full cardiac arrest (no pulse and no breathing).

  • Warning signs can include a complaint of:
  • Chest Discomfort
  • Unusual Shortness of Breath
  • Racing or Irregular Heartbeat
  • Fainting or Passing Out

EMERGENCY SIGNS – Call EMS (911)

  • If a person experiences any of the following signs, call EMS (911) immediately:
  • If an athlete collapses suddenly during competition
  • If a blow to the chest from a ball, puck or another player precedes an athlete’s complaints of any of the warning signs of sudden cardiac arrest
  • If an athlete does not look or feel right and you are just not sure

How can I help my child prevent a sudden cardiac arrest?

  • Daily physical activity, proper nutrition, and adequate sleep are all important aspects of lifelong health. Additionally, parents can assist student athletes prevent a sudden cardiac arrest by:
  • Ensuring your child knows about any family history of sudden cardiac arrest (onset of heart disease in a family member before the age of 50 or a sudden, unexplained death at an early age)
  • Ensuring your child has a thorough preseason screening exam prior to participation in an organized athletic activity
  • Asking if your school and the site of competition has an automatic defibrillator (AED) that is close by and properly maintained
  • Learning CPR yourself
  • Ensuring your child is not using any non-prescribed stimulants or performance enhancing drugs
  • Being aware that the inappropriate use of prescription medications or energy drinks can increase risk
  • Encouraging your child to be honest and report symptoms of chest discomfort, unusual shortness of breath, racing or irregular heartbeat, or feeling faint

What should I do if I think my child has warning signs that may lead to sudden cardiac arrest?

1. Tell your child’s coach about any previous events or family history

2. Keep your child out of play

3. Seek medical attention right away

Developed and Reviewed by the Indiana Department of Education’s Sudden Cardiac Arrest Advisory Board (1-7-15)

HEADS UP CONCUSSION FOR PARENTS

What is a concussion?

A concussion is a brain injury. Concussions are caused by a bump, blow, or jolt to the head or body. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious.

What are the signs and symptoms?

You can’t see a concussion. Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days after the injury. If your teen reports one or more symptoms of concussion listed below, or if you notice the symptoms yourself, keep your teen out of play and seek medical attention right away.

Signs Observed by Parents or Guardians

Appears dazed or stunned

  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms Reported by Athlete

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light or noise
  • Feeling sluggish, hazy, foggy or groggy
  • Concentration or memory problems
  • Confusion
  • Just not “feeling right” or is “feeling down”

How can you help your teen prevent a concussion?

Every sport is different, but there are steps your teens can take to protect themselves from concussion and other injuries.

  • Make sure they wear the right protective equipment for their activity. It should fit properly, be well maintained, and be worn consistently and correctly.
  • Ensure that they follow their coaches' rules for safety and the rules of the sport.
  • Encourage them to practice good sportsmanship at all times.

What should you do if you think your teen has a concussion?

Keep your teen out of play.If your teen has a concussion,her/his brain needs time to heal. Don’t let your teen return to play the day of the injury and until a health care professional, experienced in evaluating for concussion,says your teen is symptom-free and it’s OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems. In rare cases,repeat concussions can result in edema (brain swelling),permanent brain damage, and even death.

Seek medical attention right away.A health care professional experienced in evaluating for concussion will be able to decide how serious the concussion is and when it is safe for your teen to return to sports.

Teach your teen that it’s not smart to play with a concussion.Rest is key after a concussion. Sometimes athletes wrongly believe that it shows strength and courage to play injured.Discourage others from pressuring injured athletes to play. Don’t let your teen convince you that s/he’s “just fine.”

Tell all of your teen’s coaches and the student’s school nurse about ANY concussion.Coaches, school nurses, and other school staff should know if your teen has ever had a concussion.Your teen may need to limit activities while s/he is recovering from a concussion. Things such as studying, driving, working on a computer, playing video games, or exercising may cause concussion symptoms to reappear or get worse. Talk to your health care professional, as well as your teen’s coaches,school nurse, and teachers. If needed, they can help adjust your teen’s school activities during her/his recovery.

If you think your teen has a concussion: Don’t assess it yourself. Take him/her out of play. Seek the advice of a health care professional.

It’s better to miss one game than the whole season.

For more information and to order additional materials free-of-charge, visit: www.cdc.gov/Concussion.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

PARENT FORM

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