{"id":853,"date":"2024-03-19T15:29:32","date_gmt":"2024-03-19T22:29:32","guid":{"rendered":"https:\/\/forms.bellevuecollege.edu\/athletics\/?page_id=853"},"modified":"2024-06-28T10:31:04","modified_gmt":"2024-06-28T17:31:04","slug":"concussion-injury-statement","status":"publish","type":"page","link":"https:\/\/forms.bellevuecollege.edu\/athletics\/concussion-injury-statement\/","title":{"rendered":"NWAC Concussion Injury Statement"},"content":{"rendered":"\n<p>Athletes, please read through the information and resources excerpted below from the NWAC Medical Handbook. At the bottom of this page you&#8217;ll be asked to sign and date that you understand the risks of participating in intercollegiate athletics.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">NWAC Medical Handbook <\/h2>\n\n\n\n<p>Click each topic below to open the section: <\/p>\n\n\n\n<div class=\"wp-block-mayflower-blocks-collapsibles accordion\" id=\"accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\">\n<div class=\"wp-block-mayflower-blocks-collapse card bg-default\"><div class=\"card-header\" id=\"heading_9d37b286-b76e-4522-8882-cb796b99a221\"><h3 class=\"mb-0\"><button class=\"btn\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapse_9d37b286-b76e-4522-8882-cb796b99a221\" aria-expanded=\"true\" aria-controls=\"collapse_9d37b286-b76e-4522-8882-cb796b99a221\"><strong>Concussion Information<\/strong>:<\/button><\/h3><\/div><div id=\"collapse_9d37b286-b76e-4522-8882-cb796b99a221\" class=\"collapse show\" aria-labelledby=\"heading_9d37b286-b76e-4522-8882-cb796b99a221\" data-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\" data-bs-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\"><div class=\"card-body bg-light text-dark\">\n<p>NWAC member institutions shall have a concussion management plan on file such that a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be immediately removed from practice or competition and evaluated by an athletics healthcare provider with experience in the evaluation and management of concussions. Student-athletes diagnosed with a concussion shall not return to activity for the reminder of that day. The team healthcare provider (e.g., team physician) or his or her designee according to the concussion management plan shall determine medical clearance.&nbsp;<\/p>\n\n\n\n<p>The concussion management plan should ensure that student-athletes are educated and presented with educational materials about the signs and symptoms of concussions. Student-athletes accept responsibility for reporting injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions. Student-athletes must acknowledge, by signing a statement, that they have received information about the signs and symptoms of concussions and that they have a responsibility to report concussion-related injuries and illnesses to a medical staff member.&nbsp;<\/p>\n\n\n\n<p>The concussion management plan should ensure when a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be immediately removed from athletics activities (e.g., competition, practice, conditioning sessions) and evaluated by a medical staff member (e.g., sports medicine staff, team physician) with experience in the evaluation and management of concussions.&nbsp;<\/p>\n\n\n\n<p>The concussion management plan precludes a student-athlete diagnosed with a concussion from returning to athletics activity (e.g., competition, practice, and conditioning sessions) for at least the remainder of that calendar day.&nbsp;<\/p>\n\n\n\n<p>The concussion management plan requires medical clearance for a student-athlete diagnosed with a concussion to return to athletics activity (for example, competition, practice, conditioning sessions) as determined by a team healthcare provider (e.g., team physician) or the physician\u2019s designee.&nbsp;<\/p>\n\n\n\n<p>All NWAC coaches shall receive educational material from their institution an annual basis regarding symptoms, signs, and management of concussions. NWAC coaches must recognize and understand their responsibility in referring any student-athlete with signs and symptoms to the medical staff as described in the concussion management plan. All NWAC coaches will need to take the concussion training provided online.&nbsp;<\/p>\n\n\n\n<p>According to the 5th International Conference on Concussion in Sport consensus statement, a sports related concussion (SRC) is defined as a traumatic brain injury induced by biomechanical forces. The common characteristics of a concussive head injury include:&nbsp;<\/p>\n\n\n\n<p>1. Causation by a direct blow either to the head, neck, face, or anywhere else that may transmit a force to the head.&nbsp;<\/p>\n\n\n\n<p>2. SRC result is a rapid onset with short-lived disruption of neurological function that typically resolves spontaneously.&nbsp;<\/p>\n\n\n\n<p>3. The neuropathological changes are usually manifest in functional disturbances rather than structural injury.&nbsp;<\/p>\n\n\n\n<p>4. SRC can result in a wide range of signs and symptoms. Recovery from a SRC is frequently sequential and in some cases may be prolonged.&nbsp;<\/p>\n\n\n\n<p>If a student-athlete at a NWAC event is suspected to have sustained a concussion, the following recommended actions should take place:&nbsp;<\/p>\n\n\n\n<p>1. The student-athlete will be removed from all activity (practice and\/or competition)&nbsp;<\/p>\n\n\n\n<p>2. The student-athlete will be evaluated by the Host Medical Director\/Athletic Trainer, or the student-athletes own athletic trainer (if they are present with the team). The Host Medical Director (AT) and\/or onsite team physician has unchallengeable medical authority regarding the student-athletes\u2019 management and return to play, in consultation with the student-athletes own athletic trainer if they are present.&nbsp;<\/p>\n\n\n\n<p>Immediate concussion assessment will include the following:&nbsp;<\/p>\n\n\n\n<p>a. Symptom screening.&nbsp;<\/p>\n\n\n\n<p>b. Physical Examination (including c-spine) and Neurological Assessment.&nbsp;<\/p>\n\n\n\n<p>c. Cognitive Assessment.&nbsp;<\/p>\n\n\n\n<p>d. Balance Assessment.&nbsp;<\/p>\n\n\n\n<p>3. This structured examination\/assessment will follow a standardized concussion assessment process such as the SCAT5 Sports Concussion Assessment Tool.&nbsp;<\/p>\n\n\n\n<p>4. If a concussion is confirmed the student-athlete will not be allowed to return to practice or play until they have progressed through a post-concussion management plan. In addition, the EAP will be activated if any of the following are evident:&nbsp;<\/p>\n\n\n\n<p>a. Suspected spinal injury.&nbsp;<\/p>\n\n\n\n<p>b. Glasgow Coma Scale of &lt; 13.&nbsp;<\/p>\n\n\n\n<p>c. Focal Neurological Deficit indicative of intracranial trauma.&nbsp;<\/p>\n\n\n\n<p>d. Prolonged Loss of Consciousness.&nbsp;<\/p>\n\n\n\n<p>e. Repeated vomiting.&nbsp;<\/p>\n\n\n\n<p>f. Worsening mental status as indicated by deteriorating neurological signs or symptoms.&nbsp;<\/p>\n\n\n\n<p>5. Additionally, for all cases of a diagnosed concussion, the injured student-athlete and another team representative (responsible adult) will be provided with instructions on concussion follow-up care and management. Those instructions must be documented along with the individual injury report indicating the diagnosis of the concussion.&nbsp;<\/p>\n\n\n\n<p>6. The concussed student-athlete will be required to follow a graduated return-to-play (RTP) program including a return-to-learn plan. Student-athletes will not be allowed to RTP until they have completed the graduated RTP protocol and have been released by an appropriately licensed healthcare professional trained in the evaluation and management of SRC.&nbsp;<\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-mayflower-blocks-collapse card bg-default\"><div class=\"card-header\" id=\"heading_574dfc3d-ead1-4783-8105-b2c2e7c23837\"><h3 class=\"mb-0\"><button class=\"btn collapsed\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapse_574dfc3d-ead1-4783-8105-b2c2e7c23837\" aria-expanded=\"false\" aria-controls=\"collapse_574dfc3d-ead1-4783-8105-b2c2e7c23837\"><strong>Resources:<\/strong><\/button><\/h3><\/div><div id=\"collapse_574dfc3d-ead1-4783-8105-b2c2e7c23837\" class=\"collapse \" aria-labelledby=\"heading_574dfc3d-ead1-4783-8105-b2c2e7c23837\" data-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\" data-bs-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\"><div class=\"card-body\">\n<p>1. <a href=\"https:\/\/bjsm.bmj.com\/content\/51\/11\/838\" target=\"_blank\" rel=\"noreferrer noopener\">Consensus statement of concussion in sport &#8212; the 5th international conference on concussion in sport held in Berlin, October 2016<\/a>; <\/p>\n\n\n\n<p>2. <a href=\"https:\/\/www.nata.org\/practice-patient-care\/health-issues\/concussion\" target=\"_blank\" rel=\"noreferrer noopener\">NATA Concussion Webpage of Position Statements, Resources, and Initiatives;<\/a>  (Oct. 2018 &#8212; link only available to NATA members)<\/p>\n\n\n\n<p>3. <a href=\"https:\/\/www.ncaa.org\/sports\/2021\/2\/10\/sport-science-institute-concussion.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">NCAA Concussion Webpage of Educational Resources, Best Practices, and Data and Research related to concussions<\/a>;  (Oct. 2018)&nbsp;<\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-mayflower-blocks-collapse card bg-default\"><div class=\"card-header\" id=\"heading_f677e7df-2477-46ab-a920-4f2cf599f8a1\"><h3 class=\"mb-0\"><button class=\"btn collapsed\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapse_f677e7df-2477-46ab-a920-4f2cf599f8a1\" aria-expanded=\"false\" aria-controls=\"collapse_f677e7df-2477-46ab-a920-4f2cf599f8a1\"><strong>Signs and Symptoms of a Concussion<\/strong>:<\/button><\/h3><\/div><div id=\"collapse_f677e7df-2477-46ab-a920-4f2cf599f8a1\" class=\"collapse \" aria-labelledby=\"heading_f677e7df-2477-46ab-a920-4f2cf599f8a1\" data-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\" data-bs-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\"><div class=\"card-body\">\n<p>Most people with a concussion recover quickly and fully. But for some people, symptoms can last for days, weeks, or longer. Each person responds differently to a concussion. Those who have a concussion in the past are also at risk of another one and may find that it takes longer to recover if they have another concussion.&nbsp;<\/p>\n\n\n\n<p><strong><em>Signs observed by coaching staffs:&nbsp;<\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Appears dazed or stunned <\/li>\n\n\n\n<li>Is confused about assignment or position<\/li>\n\n\n\n<li>Forgets plays <\/li>\n\n\n\n<li>Is unsure of game, score, or opponent<\/li>\n\n\n\n<li>Moves clumsily<\/li>\n\n\n\n<li>Answers questions slowly<\/li>\n\n\n\n<li>Loses consciousness (even briefly)<\/li>\n\n\n\n<li>Shows behavior or personality changes<\/li>\n\n\n\n<li>Can\u2019t recall events prior to hit or fall<\/li>\n\n\n\n<li>Can\u2019t recall events after hit or fall <\/li>\n<\/ul>\n\n\n\n<p><strong><em>Symptoms reported by student<\/em><\/strong>\u2010<strong><em>athletes:&nbsp;<\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Headache or \u201cpressure\u201d in head<\/li>\n\n\n\n<li>Nausea or vomiting&nbsp;<\/li>\n\n\n\n<li>Balance problems or dizziness<\/li>\n\n\n\n<li>Double or blurry vision&nbsp;<\/li>\n\n\n\n<li>Sensitivity to light<\/li>\n\n\n\n<li>Sensitivity to noise&nbsp;<\/li>\n\n\n\n<li>Feeling sluggish, hazy, foggy, or groggy<\/li>\n\n\n\n<li>Concentration or memory problems<\/li>\n\n\n\n<li>Confusion <\/li>\n\n\n\n<li>Does not \u201cfeel right\u201d<\/li>\n<\/ul>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-mayflower-blocks-collapse card bg-default\"><div class=\"card-header\" id=\"heading_5401a0ec-4db2-4547-b333-1e3af0c6a565\"><h3 class=\"mb-0\"><button class=\"btn collapsed\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapse_5401a0ec-4db2-4547-b333-1e3af0c6a565\" aria-expanded=\"false\" aria-controls=\"collapse_5401a0ec-4db2-4547-b333-1e3af0c6a565\"><strong>Prevention and Preparation (includes video links):<\/strong><\/button><\/h3><\/div><div id=\"collapse_5401a0ec-4db2-4547-b333-1e3af0c6a565\" class=\"collapse \" aria-labelledby=\"heading_5401a0ec-4db2-4547-b333-1e3af0c6a565\" data-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\" data-bs-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\"><div class=\"card-body\">\n<p>Coaches play a vital role in preventing concussions and responding to them properly. All coaches must view the three short videos on concussion to better understand the many facts of concussions and recovery.&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.cdc.gov\/headsup\/basics\/concussion_whatis.html\">CDC &#8211; Centers for Disease Control and Prevention, HEADS UP, Brain Injury Basics: What is a concussion<\/a>.<\/li>\n\n\n\n<li><a href=\"https:\/\/www.youtube.com\/watch?v=sEFQkMo_Oe0\">UW TV Video: Recognizing Sports Concussions: Keeping Youth Athletes Safe<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/s3.amazonaws.com\/ncaa\/web_video\/health_and_safety\/concussion\/concussion.html\">NCAA Concussions Video: Don&#8217;t Hide It, Report It, Take Time to Recover<\/a><\/li>\n<\/ul>\n\n\n\n<p><strong><em>Following are some steps coaches can take to ensure the best outcome of student<\/em>\u2010<em>athletes:&nbsp;<\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Educate student\u2010athletes and coaching staff about concussion. Explain your concerns about concussion and your expectations of safe play to student\u2010athletes, staff members, and assistant coaches. Create an environment that supports reporting, access to proper evaluation, and conservative return\u2010to\u2010play.&nbsp;<\/li>\n\n\n\n<li>Review and practice your emergency action plan for your facility.&nbsp;<\/li>\n\n\n\n<li>Know when you will have sideline medical care and when you will not for both home and away games.&nbsp;<\/li>\n\n\n\n<li>Emphasize that protective equipment should fit properly, be well maintained, and be worn consistently and correctly.&nbsp;<\/li>\n\n\n\n<li>Review the Concussion Fact Sheet for Student\u2010Athletes with your team to help them recognize the signs of a concussion.&nbsp;<\/li>\n\n\n\n<li>Insist that safety comes first.&nbsp;<\/li>\n\n\n\n<li>Teach student\u2010athletes safe\u2010play techniques and encourage them to follow the rules of play.&nbsp;<\/li>\n\n\n\n<li>Encourage student\u2010athletes to practice good sportsmanship at all times.&nbsp;<\/li>\n\n\n\n<li>Encourage student\u2010athletes to immediately report symptoms of concussion.&nbsp;<\/li>\n\n\n\n<li>Prevent long\u2010term problems. A repeat concussion that occurs before the brain recovers from the previous one (hours, days, or weeks) can slow recovery or increase the likelihood of having long\u2010term problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage, and even death.&nbsp;<\/li>\n<\/ul>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-mayflower-blocks-collapse card bg-default\"><div class=\"card-header\" id=\"heading_241ca5d1-06b7-4372-897b-424c58c4cb02\"><h3 class=\"mb-0\"><button class=\"btn collapsed\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapse_241ca5d1-06b7-4372-897b-424c58c4cb02\" aria-expanded=\"false\" aria-controls=\"collapse_241ca5d1-06b7-4372-897b-424c58c4cb02\"><strong>If You Think Your Student Athlete Has Sustained a Concussion:<\/strong><\/button><\/h3><\/div><div id=\"collapse_241ca5d1-06b7-4372-897b-424c58c4cb02\" class=\"collapse \" aria-labelledby=\"heading_241ca5d1-06b7-4372-897b-424c58c4cb02\" data-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\" data-bs-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\"><div class=\"card-body\">\n<p>Take him\/her out of play immediately and allow adequate time for evaluation by a health care professional experienced in evaluating for concussion. An athlete who exhibits signs, symptoms, or behaviors consistent with a concussion, both at rest or during exertion, should be removed immediately from practice or competition and should not return to play until cleared by an appropriate health care professional. Sports have injury timeouts and player substitutions so that student\u2010athletes can get checked out.&nbsp;<\/p>\n\n\n\n<p><strong>Remove the student<\/strong>\u2010<strong>athlete from play. <\/strong>Look for the signs and symptoms of concussion if your student\u2010athlete has experienced a blow to the head. Do not allow the student\u2010athlete to just \u201cshake it off.\u201d Each individual athlete will respond to concussions differently.&nbsp;<\/p>\n\n\n\n<p><strong>Ensure that an appropriate health care professional right away evaluates the student<\/strong>\u2010<strong>athlete. <\/strong>Do not try to judge the severity of the injury yourself. Immediately refer the student\u2010athlete to the appropriate athletics medical staff, such as a certified athletic trainer, team physician, or health care professional experienced in concussion evaluation and management.&nbsp;<\/p>\n\n\n\n<p><strong>Allow the student<\/strong>\u2010<strong>athlete to return to play only with permission from a health care professional with experience in evaluating for concussion. <\/strong>Allow athletic medical staff to rely on their clinical skills and protocols in evaluating the athlete to establish the appropriate time to return to play. A return\u2010to\u2010play progression should occur in an individualized, stepwise fashion with gradual increments in physical exertion and risk of contact.&nbsp;<\/p>\n\n\n\n<p><strong>Develop a game plan. <\/strong>Student\u2010athletes should not return to play until all symptoms have resolved both at rest and during exertion. Many times, which means they will be out for the remainder of that day. In fact, as concussion management continues to evolve with new science, the care is becoming more conservative and return\u2010to\u2010play time frames are getting longer. Coaches should have a game plan that accounts for this change.&nbsp;<\/p>\n\n\n\n<p><strong>Lystedt Law: <\/strong>Washington State\u2019s concussion law became effective in July 2009. The main provisions apply to school districts and athletic leagues who utilize school district property:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Removal of any athlete suspected of having a concussion from practice\/game under age 18.&nbsp;<\/li>\n\n\n\n<li>Athletes cannot return to practice\/game until evaluated by a licensed physician or their designee trained in the diagnosis and management of concussions and given written medical authorization.&nbsp;<\/li>\n<\/ul>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-mayflower-blocks-collapse card bg-default\"><div class=\"card-header\" id=\"heading_7a7e13fc-6964-4c97-9f4b-92e3fa4e563e\"><h3 class=\"mb-0\"><button class=\"btn collapsed\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapse_7a7e13fc-6964-4c97-9f4b-92e3fa4e563e\" aria-expanded=\"false\" aria-controls=\"collapse_7a7e13fc-6964-4c97-9f4b-92e3fa4e563e\"><strong>Additional Information (includes fact sheets)<\/strong>:<\/button><\/h3><\/div><div id=\"collapse_7a7e13fc-6964-4c97-9f4b-92e3fa4e563e\" class=\"collapse \" aria-labelledby=\"heading_7a7e13fc-6964-4c97-9f4b-92e3fa4e563e\" data-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\" data-bs-parent=\"#accordion_0cde4bf3-e7f7-4ebe-8628-5ff1c592688d\"><div class=\"card-body\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/ncaaorg.s3.amazonaws.com\/ssi\/concussion\/SSI_ConcussionFactSheet_StudentAthletes.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">NCAA Concussion Fact Sheet for Students<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/ncaaorg.s3.amazonaws.com\/ssi\/concussion\/SSI_ConcussionFactSheet_Coaches.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"> NCAA Concussion Fact Sheet for Coaches <\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.cdc.gov\/TraumaticBrainInjury\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;CDC &#8211; Centers for Disease Control :Traumatic Brain Injury &amp; Concussion<\/a><\/li>\n<\/ul>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n\n\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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Student-Athlete Concussion Injury Statement<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_121' id='gform_121'  action='\/athletics\/wp-json\/wp\/v2\/pages\/853#gf_121' data-formid='121' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_121' class='gform_fields top_label form_sublabel_below description_above validation_below'><fieldset id=\"field_121_1\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Reporting All Injuries and Illnesses<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_121_1' tabindex='0'><big>I understand that it is my responsibility to report all injuries and illnesses to my athletic trainer\/athletic health care provider and\/or team physician.<\/big><\/div><div class='ginput_container ginput_container_consent'><input name='input_1.1' id='input_121_1_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_121_1\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_121_1_1' >I understand and agree.<\/label><input type='hidden' name='input_1.2' value='I understand and agree.' class='gform_hidden' \/><input type='hidden' name='input_1.3' value='346' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_121_3\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >NCAA Concussion Fact Sheet and NCAA Concussions Video<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_121_3' tabindex='0'><big>I have read and understand the <a href=\"https:\/\/ncaaorg.s3.amazonaws.com\/ssi\/concussion\/SSI_ConcussionFactSheet_StudentAthletes.pdf\" target=\"blank\">NCAA Fact Sheet for Students [PDF]<\/a> and have viewed the <a href=\"https:\/\/s3.amazonaws.com\/ncaa\/web_video\/health_and_safety\/concussion\/concussion.html\" target=\"blank\">NCAA Concussions Video: Don&#8217;t Hide It, Report It, Take Time to Recover<\/a>.<\/big><\/div><div class='ginput_container ginput_container_consent'><input name='input_3.1' id='input_121_3_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_121_3\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_121_3_1' >I have read and understand the fact sheet and have viewed the video.<\/label><input type='hidden' name='input_3.2' value='I have read and understand the fact sheet and have viewed the video.' class='gform_hidden' \/><input type='hidden' name='input_3.3' value='346' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_121_4\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><big><strong>After reading the NCAA Concussion Fact Sheet and viewing the Concussion Video, I am aware of the following information:<\/strong><\/big>\n<ul><li>\nA concussion is a brain injury, which I am responsible for reporting to my athletic trainer\/athletic health care provider or team physician.<\/li>\n<li>A concussion can affect my ability to perform everyday activities, affect reaction time, balance, sleep, and classroom performance.<\/li>\n<li>You cannot see a concussion, but you might notice some of the symptoms right away. Oher symptoms can show up hours or days after injury.<\/li>\n<li>If I suspect a teammate has a concussion, I am responsible for reporting the injury to the athletic trainer\/athletic health care provider or team physician.<\/li>\n<li>I will not return to practice or play in a contest if I have received a blow to the head or body that results in concussion related symptoms.<\/li>\n<li>Following a concussion, the brain needs time to heal. You are much more likely to have a repeat concussion if you return to play before your symptoms resolve.<\/li>\n<li>In rare cased, repeat concussion can cause permanent brain damage, and even death.<\/li><\/ul>\n<strong>I have read the above information noted here by reference, and I understand the risk of injury or death. 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