Kick And Roll Academy
KICK AND ROLL ACADEMY (K.A.R.A.)
Participant’s Name:
A concussion is an injury that changes how the cells in the brain normally work. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious.
Observed by the Athlete:
• 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 or concentrating
• Memory problems
• Confusion
• Does not “feel right”
Observed by Parent/Guardian, Coach, or Others:
• 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 behavior or personality changes
• Can’t recall events before or after the hit or fall
• Athlete: Tell your coach or instructor immediately, inform your parents, seek medical attention, and give yourself time to recover.
• Parent/Guardian: Seek medical attention right away, keep your child out of all activity, and discuss return to activity with the coach/instructor.
• Continuing to train or participate after a suspected concussion can be dangerous and may lead to more serious injury or even death.
• Most concussions occur without loss of consciousness.
• You cannot see a concussion — symptoms can appear right away or days later.
• Return to activity only after receiving written clearance from a qualified healthcare provider.
• Centers for Disease Control and Prevention: www.cdc.gov/concussion
• Arkansas Activities Association Sports Medicine resources
I acknowledge that I have received and reviewed this Concussion & Head Injury Information Sheet.
Parent/Guardian Signature:
Participant Signature (if 13 or older):