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“The Lystedt Law” House Bill 1824”
Page 1
HEADS UP: CONCUSSION IN YOUTH SPORTS
A Fact Sheet for UKCBSA Parents and UKCBSA Athletes
(Requirement to Read and Signed by parents and athletes)
This form must be return with registration in order for your child to eligible to play.
WHAT IS A CONCUSSION?
A concussion is a brain injury that is caused by a bump or blow to the head. It can change the way your brain normally
works. It can occur during practices or games in any sport. Even a “ding,” “getting your bell rung,” or what seems to be a
mild bump or blow to the head can be serious. A concussion can happen even if you haven't been knocked out. You can’t
see a concussion. Signs and symptoms of a concussion can show up right after the injury or may not appear or be noticed
until days or weeks after the injury. If your child reports any symptoms of concussion, or if you notice the symptoms
yourself, seek medical attention right away.
PARENTS AND GUARDIANS
What are the signs and symptoms of a concussion observed by Parents/Guardians:
If your child has experienced a bump or blow to the head during a game or practice, look for any of the following signs and
symptoms of a concussion:
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 prior to being hit or falling
Can’t recall events after being hit or falling
How can a Parent/Guardian help their child prevent a concussion?
Every sport is different, but there are steps your children can take to protect themselves from concussion.
Ensure that they follow their coach’s rules for safety and the rules of the sport.
Encourage them to practice good sportsmanship at all times.
Make sure they wear the right protective equipment for their activity (such as helmets, padding, shin guards, and eye
and mouth guards). Protective equipment should fit properly, be well maintained, and be worn consistently and correctly.
Learn the signs and symptoms of a concussion.
What should a Parent/Guardian do if they think their child has a concussion?
1. Seek medical attention right away. A health care professional will be able to decide how serious the concussion is
and when it is safe for your child to return to sports. Notify your child's coach if you think your child has a concussion.
2. Keep your child out of play. Concussions take time to heal. Don’t let your child return to play until a health care
professional says it’s OK. Children who return to play too soon—while the brain is still healing—risk a greater chance of
having a second concussion. Second or later concussions can be very serious. They can cause permanent brain damage,
affecting your child for a lifetime.
3. Tell your child’s coach about any recent concussion in ANY sport or activity. Your child’s coach may not know about
a concussion your child received in another sport or activity unless you tell the coach.
ATHLETES
What are the symptoms of a concussion?
Headache or “pressure” in head
Nausea or vomiting
Balance problems or dizziness Educational Video For Coaches & Parents
Double or blurry vision
Bothered by light
Bothered by noise
Feeling sluggish, hazy, foggy, or groggy
Difficulty paying attention
Memory problems
Confusion
Does not “feel right”
Page 2
HEADS UP: CONCUSSION IN YOUTH SPORTS
A Fact Sheet for UKCBSA Parents and UKCBSA Athletes
(Requirement to Read and Signed by parents and athletes)
This form must be return with registration in order for your child to eligible to play.
What should an athlete do if they think they 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 if one of your teammates might have a concussion.
Get a medical check up. A doctor or health care professional can tell you if you have a concussion and when you are
OK to return to play.
Give yourself time to get better. If you have had aconcussion, your brain needs time to heal. While your brain is still
healing, you are much more likely to have a second concussion. Second or later concussions can cause damage to your
brain. It is important to rest until you get approval from a doctor or health care professional to return to play.
It is better to miss one game than the whole season. How can athletes prevent a concussion?
Every sport is different, but there are steps you can take to protect yourself.
Follow your coach’s rules for safety and the rules of the sport.
Practice good sportsmanship at all times.
Use the proper sports equipment, including personal protective equipment (such as helmets, padding, shin guards,
and eye and mouth guards). In order for equipment to protect you, it must be:
The right equipment for the game, position, or activity
Worn correctly and fit well
Used every time you play
Repaired and maintained
Student Signature: _______________________________________________________Date:__________________
Parent/Guardian Signature:________________________________________________ Date:__________________
IT’S BETTER TO MISS ONE GAME THAN THE WHOLE SEASON.
For more detailed information on concussion and traumatic brain injury, visit:
http://www.cdc.gov/injury or www.cdc.gov/ConcussionInYouthSports
Page 1
HEADS UP: CONCUSSION IN YOUTH SPORTS
A Fact Sheet for UKCBSA Parents and UKCBSA Athletes
(Requirement to Read and Signed by parents and athletes)
This form must be return with registration in order for your child to eligible to play.
WHAT IS A CONCUSSION?
A concussion is a brain injury that is caused by a bump or blow to the head. It can change the way your brain normally
works. It can occur during practices or games in any sport. Even a “ding,” “getting your bell rung,” or what seems to be a
mild bump or blow to the head can be serious. A concussion can happen even if you haven't been knocked out. You can’t
see a concussion. Signs and symptoms of a concussion can show up right after the injury or may not appear or be noticed
until days or weeks after the injury. If your child reports any symptoms of concussion, or if you notice the symptoms
yourself, seek medical attention right away.
PARENTS AND GUARDIANS
What are the signs and symptoms of a concussion observed by Parents/Guardians:
If your child has experienced a bump or blow to the head during a game or practice, look for any of the following signs and
symptoms of a concussion:
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 prior to being hit or falling
Can’t recall events after being hit or falling
How can a Parent/Guardian help their child prevent a concussion?
Every sport is different, but there are steps your children can take to protect themselves from concussion.
Ensure that they follow their coach’s rules for safety and the rules of the sport.
Encourage them to practice good sportsmanship at all times.
Make sure they wear the right protective equipment for their activity (such as helmets, padding, shin guards, and eye
and mouth guards). Protective equipment should fit properly, be well maintained, and be worn consistently and correctly.
Learn the signs and symptoms of a concussion.
What should a Parent/Guardian do if they think their child has a concussion?
1. Seek medical attention right away. A health care professional will be able to decide how serious the concussion is
and when it is safe for your child to return to sports. Notify your child's coach if you think your child has a concussion.
2. Keep your child out of play. Concussions take time to heal. Don’t let your child return to play until a health care
professional says it’s OK. Children who return to play too soon—while the brain is still healing—risk a greater chance of
having a second concussion. Second or later concussions can be very serious. They can cause permanent brain damage,
affecting your child for a lifetime.
3. Tell your child’s coach about any recent concussion in ANY sport or activity. Your child’s coach may not know about
a concussion your child received in another sport or activity unless you tell the coach.
ATHLETES
What are the symptoms of a concussion?
Headache or “pressure” in head
Nausea or vomiting
Balance problems or dizziness Educational Video For Coaches & Parents
Double or blurry vision
Bothered by light
Bothered by noise
Feeling sluggish, hazy, foggy, or groggy
Difficulty paying attention
Memory problems
Confusion
Does not “feel right”
Page 2
HEADS UP: CONCUSSION IN YOUTH SPORTS
A Fact Sheet for UKCBSA Parents and UKCBSA Athletes
(Requirement to Read and Signed by parents and athletes)
This form must be return with registration in order for your child to eligible to play.
What should an athlete do if they think they 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 if one of your teammates might have a concussion.
Get a medical check up. A doctor or health care professional can tell you if you have a concussion and when you are
OK to return to play.
Give yourself time to get better. If you have had aconcussion, your brain needs time to heal. While your brain is still
healing, you are much more likely to have a second concussion. Second or later concussions can cause damage to your
brain. It is important to rest until you get approval from a doctor or health care professional to return to play.
It is better to miss one game than the whole season. How can athletes prevent a concussion?
Every sport is different, but there are steps you can take to protect yourself.
Follow your coach’s rules for safety and the rules of the sport.
Practice good sportsmanship at all times.
Use the proper sports equipment, including personal protective equipment (such as helmets, padding, shin guards,
and eye and mouth guards). In order for equipment to protect you, it must be:
The right equipment for the game, position, or activity
Worn correctly and fit well
Used every time you play
Repaired and maintained
Student Signature: _______________________________________________________Date:__________________
Parent/Guardian Signature:________________________________________________ Date:__________________
IT’S BETTER TO MISS ONE GAME THAN THE WHOLE SEASON.
For more detailed information on concussion and traumatic brain injury, visit:
http://www.cdc.gov/injury or www.cdc.gov/ConcussionInYouthSports
UPPER KITTITAS COUNTY YOUTH BASEBALL/SOFTBALL ASSOCIATION
PLAYER WAIVER / HOLD HARMLESS AGREEMENT & PHOTO AUTHORIZATION
THIS FORM MUST BE FILLED OUT COMPLETELY AND ATTACHED TO REGESTRATION IN ORDER FOR
YOUR CHILD TO BE ELIGILE TO PLAY
My Child, _______________________________________ has my permission to participate in Upper Kittitas County Youth
Baseball/Softball.
As a condition of his/her participation, I certify the following:
_____I am the parent or guardian and have the authority to give consent and make this waiver.
_____I understand that U.K.C. Youth Baseball/Softball is an independent, nonprofit organization with few assets and is
affiliated with Babe Ruth League, Inc. & Cal Ripken league, Inc.
_____I understand that Youth Baseball/Softball, like any other sport, can be dangerous and that children can be
injured while participating in Association activities. I have made an independent decision that the benefit to my child
exceeds the risk and I want him/her to participate.
_____I agree on my own behalf, and on behalf of my child to waive any claims that I might have against U.K.C. Youth
Baseball/Softball Association, its trustees, officers, officials, coaches, and members for any injury arising out of my child’s
participation in Youth Baseball/Softball. I further agree that neither I, nor my child, nor any member of my family shall file a
lawsuit against Upper Kittitas County Youth Baseball/Softball Association, its officials or members for any injury resulting
from my child’s participation in U.K.C. Youth Baseball/Softball.
_____ I give my permission for my child to be photographed as a part of his/her participation in U.K.C.Y.B.A. (Upper Kittitas
County Youth Baseball/Softball Association) program. I understand that his/her photograph will only be used to promote
the activities of this Association and/or in newspaper print promoting youth baseball or softball. I also understand that
his/her photographs may be used in U.K.C.Y.B.A.’s web-site, and may also be used in future ads for this Association.
Printed Name of Parent/Guardian:
______________________________________________________________
Signature of Parent/Guardian:
________________________________________Date: _________________
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