1 Name Parent address: Student address: Grade Student ID Sport Gender Student Athlete and Parent Packet.441;1Pw PGC 9 r-eazi 6:V ee Office of Interscholastic Athletics 4400 Shell Street Capitol Heights, MD Phone: Fax: Earl Hawkins, Director Interscholastic Athletics O'Shay Watson, Supervisor Interscholastic Athletics Member of the Maryland Public Secondary Schools Athletic Association
2 -.0.-,, PGCPS 9,teat 4 eitoiee Prince George's County Public Schools SCHOOL LANE UPPER MARLBORO, MARYLAND Parental Permission for Participation in Interscholastic Athletics Please fill in the appropriate blanks and return this form to the head coach of the sport in which you wish your son/daughter to participate. Permission to participate is not granted unless this form is signed by the parent or legal guardian. Permission applies only to the sport specified. A new form must be submitted if guardianship or insurance information changes. My child, First Name Last Name in the following Prince George's County athletic program for the school year, has my permission to participate SPORT SCHOOL Parent/Guardian Signature Date Address Home Phone Work Phone The school does not provide insurance coverage for athletes other than the group catastrophic policy for county football programs, All participants should have their own insurance coverage in effect at the time of participation to cover accidental injuries that might arise. My child has injury insurance coverage under policy # through Insurance Company Parent/Guardian Signature Date In case of an emergency in which your child needs immediate medical treatment, we will send him/her to the nearest hospital and notify you immediately. The phone numbers you supply are of the utmost importance and should be updated when a change occurs. Please list your doctor's name and phone number so that he may be contacted if necessary: Name of Doctor Phone Number(s) PGIN (4/95) Board of Education of Prince George's County
3 PREPARTICIPATION PHYSICAL EVALUATION HISTORY FORM (Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the ohm') Date of Exam Name Date of birth Sex Age Grade School Sport(s) Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking Do you have any allergies? 0 Yes 0 No If yes, please identify specific allergy below. 0 Medicines 0 Pollens 0 Food 0 Stinging Insects Explain "Yes" answers below. Circle questions you don't know the answers to. GENERAL QUESTIONS Yes No 1. Has a doctor ever denied or restricted your participation in sports for any reason? 2. Do you have any ongoing medical conditions? If so, please identify below: 0 Asthma 0 Anemia 0 Diabetes 0 Infections Other: 3. Have you ever spent the night in the hospital? 4. Have you ever had surgery? HEART HEALTH QUESTIONS ABOUT YOU Yes No 5. Have you ever passed out or nearly passed out DURING or AFTER exercise? 6. Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise? 7. Does your heart ever race or skip beats (irregular beats) during exercise? 8. Has a doctor ever told you that you have any heart problems? If so, check all that apply: 0 High blood pressure 0 A heart murmur 0 High cholesterol 0 A heart infection 0 Kawasaki disease Other 9. Has a doctor ever ordered a test for your heart? (For example, ECG/EKG, echocardiogram) 10. Do you get lightheaded or feel more short of breath than expected during exercise? 11. Have you ever had an unexplained seizure? 12. Do you get more tired or short of breath more quickly than your friends during exercise? HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Yes No 13. Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident, or sudden infant death syndrome)? 14. Does anyone in your family have hypertrophic cardiomyopathy, Marian syndrome, arrhythmogenic right ventricular cardiomyopathy, long DT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia? 15. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator? 16. Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning? BONE AND JOINT QUESTIONS Yes No 17. Have you ever had an injury to a bone, muscle, ligament, or tendon that caused you to miss a practice or a game? 18. Have you ever had any broken or fractured bones or dislocated joints? 19. Have you ever had an injury that required x-rays, MRI, CT scan, injections, therapy, a brace, a cast, or crutches? 20. Have you ever had a stress fracture? 21. Have you ever been told that you have or have you had an x-ray for neck instability or atlantoaxial instability? (Down syndrome or dwarfism) 22. Do you regularly use a brace, orthotics, or other assistive device? 23. Do you have a bone, muscle, or joint injury that bothers you? 24. Do any of your joints become painful, swollen, feel warm, or look red? 25. Do you have any history of juvenile arthritis or connective tissue disease? MEDICAL QUESTIONS Yes No 26. Do you cough, wheeze, or have difficulty breathing during or after exercise? 27. Have you ever used an inhaler or taken asthma medicine? 28. Is there anyone in your family who has asthma? 29. Were you born without or are you missing a kidney, an eye, a testicle (males), your spleen, or any other organ? 30. Do you have groin pain or a painful bulge or hernia in the groin area? 31. Have you had infectious mononucleosis (mono) within the last month? 32. Do you have any rashes, pressure sores, or other skin problems? 33. Have you had a herpes or MRSA skin infection? 34. Have you ever had a head injury or concussion? 35. Have you ever had a hit or blow to the head that caused confusion, prolonged headache, or memory problems? 36. Do you have a history of seizure disorder? 37. Do you have headaches with exercise? 38. Have you ever had numbness, tingling, or weakness in your arms or legs after being hit or falling? 39. Have you ever been unable to move your arms or legs after being hit or falling? 40. Have you ever become ill while exercising in the heat? 41. Do you get frequent muscle cramps when exercising? 42. Do you or someone in your family have sickle cell trait or disease? 43. Have you had any problems with your eyes or vision? 44. Have you had any eye injuries? 45. Do you wear glasses or contact lenses? 46. Do you wear protective eyewear, such as goggles or a face shield? 47. Do you worry about your weight? 48. Are you trying to or has anyone recommended that you gain or lose weight? 49. Are you on a special diet or do you avoid certain types of foods? 50. Have you ever had an eating disorder? 51. Do you have any concerns that you would like to discuss with a doctor? FEMALES ONLY 52. Have you ever had a menstrual period? 53. How old were you when you had your first menstrual period? 54. How many periods have you had in the last 12 months? Explain "yes" answers here I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. Signature of athlete Signature of parent/guardian Date 2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. HE /0410
4 PREPARTICIPATION PHYSICAL EVALUATION THE ATHLETE WITH SPECIAL NEEDS: SUPPLEMENTAL HISTORY FORM Date of Exam Name Date of birth Sex Age Grade School Sport(s) 1. Type of disability 2. Date of disability 3. Classification (if available) 4. Cause of disability (birth, disease, accident/trauma, other) 5. List the sports you are interested in playing 6. Do you regularly use a brace, assistive device, or prosthetic? 7. Do you use any special brace or assistive device for sports? 8. Do you have any rashes, pressure sores, or any other skin problems? 9. Do you have a hearing loss? Do you use a hearing aid? 10. Do you have a visual impairment? 11. Do you use any special devices for bowel or bladder function? 12. Do you have burning or discomfort when urinating? 13. Have you had autonomic dysreflexia? 14. Have you ever been diagnosed with a heat-related (hyperthermia) or cold-related (hypothermia) illness? 15. Do you have muscle spasticity? 16. Do you have frequent seizures that cannot be controlled by medication? Explain "yes" answers here Yes No Please indicate if you have ever had any of the following. Atlantoaxial instability X-ray evaluation for atlantoaxial instability Dislocated joints (more than one) Easy bleeding Enlarged spleen Hepatitis Osteopenia or osteoporosis Difficulty controlling bowel Difficulty controlling bladder Numbness or tingling in arms or hands Numbness or tingling in legs or feet Weakness in arms or hands Weakness in legs or feet Recent change in coordination Recent change in ability to walk Spina bifida Latex allergy Explain "yes" answers here Yes No I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. Signature of athlete Signature of parent/guardian Date 2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.
5 PREPARTICIPATION PHYSICAL EVALUATION PHYSICAL EXAMINATION FORM Name Date of birth PHYSICIAN REMINDERS 1. Consider additional questions on more sensitive issues Do you feel stressed out or under a lot of pressure? Do you ever feel sad, hopeless, depressed, or anxious? Do you feel safe at your home or residence? Have you ever tried cigarettes, chewing tobacco, snuff, or dip? During the past 30 days, did you use chewing tobacco, snuff, or dip? Do you drink alcohol or use any other drugs? Have you ever taken anabolic steroids or used any other performance supplement? Have you ever taken any supplements to help you gain or lose weight or improve your performance? Do you wear a seat belt, use a helmet, and use condoms? 2. Consider reviewing questions on cardiovascular symptoms (questions 5-14). EXAMINATION Height Weight 0 Male 0 Female BP / ( / ) Pulse Vision R 20/ [20/ Corrected OY ON MEDICAL NORMAL ABNORMAL FINDINGS Appearance Marfan stigmata (lophoscoliosis, high-arched palate, pectus excavatum, arachnodactyly, arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency) Eyes/ears/nose/throat Pupils equal Hearing Lymph nodes Heart' Murmurs (auscultation standing, supine, +/- Valsalva) Location of point of maximal impulse (PMI) Pulses Simultaneous femoral and radial pulses Lungs Abdomen Genitourinary (males only) Skin HSV, lesions suggestive of MRSA, tinea corporis Neurologic' MUSCULOSKELETAL Neck Back Shoulder/arm Elbow/forearm Wrist/band/fingers Hip/thigh Knee Leg/ankle Foot/toes Functional Duck-walk, single leg hop 'Consider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. 'Consider GU exam if in private setting. Having third party present is recommended. `Consider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion. O Cleared for all sports without restriction Cleared for all sports without restriction with recommendations for further evaluation or treatment for O Not cleared O Pending further evaluation o For any sports DI For certain sports Reason Recommendations I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians). Name of physician (print/type) Date Address Signature of physician Phone, MD or DO C)2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. 11E /G410
6 PREPARTICIPATION PHYSICAL EVALUATION CLEARANCE FORM Name Sex 0 M 0 F Age Date of birth O Cleared for all sports without restriction o Cleared for all sports without restriction with recommendations for further evaluation or treatment for O Not cleared O Pending further evaluation o For any sports O For certain sports Reason Recommendations I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians). Name of physician (print/type) Date Address Signature of physician Phone, MD or DO EMERGENCY INFORMATION Allergies Other information 2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.
7 MEDICAL CARD FOR ATHLETE Office of Interscholastic Athletics PRINCE GEORGE'S COUNTY PUBLIC SCHOOLS MEDICAL CARD FOR ATHLETE INSTRUCTIONS: This card should be kept on file in the medical kit for each sport. It should accompany the athlete to the doctor or hospital when medical attention is required. School Name Jersey Number Student Name Phone # ( Alternate Home Address Phone # ( Date of Birth Physician Family Physician Phone # ( Date of Last Hospital Preference Tetanus Shot Allergies Medicine Administered on the Field PGIN (OVER)
8 MEDICAL CARD FOR ATHLETE INSURANCE INFORMATION: Does your son/daughter have medical insurance? 0 Yes 0 No If Yes, name of insurance company RELEASE FOR TREATMENT: I hereby give permission to the attending physician or hospital to administer appropriate medical treatment in the event I can not be reached. Signature, Parent/Guardian I Date I This Card Must Be Kept On File In The Medical Kit For Each Sport. It Must Accompany The Athlete To The Doctor Or Hospital When Medical Attention Is Required.
9 Eligibility Checklist for High School Students Please read the following statements carefully and provide a response for each statement. You must be eligible to participate in Interscholastic Athletics. Please review the following checklist with your parents. If you have questions, see your coach, athletic director and/or principal. Return this signed form to your head coach or athletic director before tryouts. I was previously enrolled at (list School) I currently enrolled in the program [where applicable]. Yes No I am officially enrolled in High School. Yes No I received a 2.0 or above with no failing grade during the previous quarter. Yes No I have changed schools (transferred). Yes No I turn 19 prior to September 1. Yes No I have been recruited to attend this school. Yes No I have had a physical examination on /_I and have submitted the signed PGCPS approved forms to my coach. Yes No I have returned my signed parental permission form to my coach. Yes No I am using anabolic steroids or other performance enhancing drugs. Yes No I have only played at my current high school [excluding club teams or AAU programs]. I reside at the following address My residence is within the boundaries of High School. Yes No I reside at the aforementioned address with my parent(s) or legal guardian. Yes No I agree to notify the coach/school of any change in residence. / / Student Name Printed Date Student's Signature Parent/Guardian's Signature Date Parent/Guardian's Address Reviewed by Athletic Director Signature Date signed
10 PRINCE GEORGE'S COUNTY PUBLIC SCHOOLS RELEASE Throughout the school year, the Board of Education of Prince George's County and individual schools within Prince George's County Public Schools will conduct activities that may be publicized through local or national news media. These activities may include interview sessions with news reporters; photographs of individual students or groups of students for newspapers or various school system publications including newsletters, calendars, and brochures; the use of student photos on the PGCPS Web site; and videotaping for local and national television news programs, cable programming, and school system promotional videos. Please check one of the two statements below. Sign and return this document to your child's school. I/We grant permission for my child's classwork, tests or assignments, CO I/we grant permission for my/our child's name, voice, and likeness to be used by Prince George's County Public Schools personnel,or reporters, journalists, or photographers employed by news media. with comments and/or grades, to be displayed. I/we do not give permission for my child's name, voice, and photographic likeness to be used by Prince George's County Public Schools personnel, or reporters, journalists, or photographers employed by news media. Child's Name School Signature of Parent(s) or Guardian(s) Signature of Parent(s) or Guardian(s) PRINCE GEORGE'S COUNTY PUBLIC SCHOOLS PGCPS ate Prince George's County Board of Education Prince George's County Public Schools School Lane Upper Marlboro, MD OFFICE OF COMMUNICATION FEBRUARY 2014
11 ESCUELAS POBLICAS DEL CONDADO DE PRINCE GEORGE PARA PUBLICAR z o AUTORIZACION PARA PUBLICAR Durante el transcurso del ciclo lectivo, la Junta Educativa del Condado de Prince George y cada establecimiento del sistema de Escuelas Pilblicas del Condado de Prince George Ilevaran a cabo actividades que podran publicarse en los medios de comunicacion local o nacional. Entre otras, tales actividades incluyen: entrevistas con periodistas, fotografias individuales o grupales de los alumnos para periodicos o publicaciones del sistema escolar (boletines de noticias, calendarios, folletos, etc.), uso de fotografias en el sitio Web de PGCPS; y filmacion para not icieros televisivos locales y nacionales, programacion de cable y filmacion de videos promocionales del sistema escolar. Por favor, responda marcando una respuesta a continuacion. Firme y envie de regreso este documento a la escuela de su hijo. Yo/Nosotros otorgamos permiso para que el trabajo en clase, pruebas o tareas de mi hijo, con comentarios y/o grados, sea mostrado. Autorizo/Autorizamos la utilizacion del nombre, la voz, o representacion fotografica de mi/nuestro hijo por parte del personal de las Escuelas Publicas del Condado de Prince George o por parte de redactores, periodistas o fotografos de los medios noticiosos. No autorizo/autorizamos la utilizacion del nombre, la voz, o representacion fotografica de mi/nuestro hijo por parte del personal de las Escuelas PUblicas del Condado de Prince George o por parte de redactores, periodistas o fotografos de los medios noticiosos. Nombre del alumno Escuela Firma del padre o tutor Firma del padre o tutor PRINCE GEORGE'S COUNTY PUBLIC SCHOOLS PGCPS Fecha Prince George's County Board of Education Prince George's County Public Schools School Lane Upper Marlboro, MD OFFICE OF COMMUNICATION FEBRERO 2014
12 Parent/Athlete Concussion Information Sheet CONCUSSION IN YOUTH SPORTS A concussion is a type of traumatic brain injury that changes the way the brain normally works. A concussion is caused by bump, blow, or jolt to the head or body that causes the head and brain to move rapidly back and forth. 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 SYMPTOWS OF CONCUSSION? Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days or weeks after the injury. If an athlete reports one or more symptoms of concussion listed below after a bump, blow, or jolt to Did You Know? Most concussions occur without loss of consciousness. Athletes who have, at any point in their lives, had a concussion have an increased risk for another concussion. Young children and teens are more likely to get a concussion and take longer to recover than adults. the head or body, s/he should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says s/he is symptom-free and it's OK to return to play. Mille tan _IJIALA.M1 ffil SE SIGNS OBSERVED BY COACHING STAFF 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 ATHLETES Headache or "pressure" in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Sensitivity to light Sensitivity to noise Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Just not "feeling right" or "feeling down"
13 -9 CONCUSSION DANGER SIGNS In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. An athlete should receive immediate medical attention if after a bump, blow, or jolt to the head or body s/he exhibits any of the following danger signs: Remember Concussions affect people differently. While most athletes with a concussion recover quickly and fully, some will have symptoms that last for days, or even weeks. A more serious concussion can last for months or longer. One pupil larger than the other Is drowsy or cannot be awakened A headache that not only does not diminish, but gets worse Weakness, numbness, or decreased coordination Repeated vomiting or nausea Slurred speech Convulsions or seizures Cannot recognize people or places Becomes increasingly confused, restless, or agitated Has unusual behavior Loses consciousness (even a brief loss of consciousness should be taken seriously) WHY SHOULD AN ATHLETE REPORT THEIR SYMPTOMS? If an athlete has a concussion, his/her brain needs time to heal. While an athlete's brain is still healing, s/he is much more likely to have another concussion. Repeat concussions can increase the time it takes to recover. In rare cases, repeat concussions in young athletes can result in brain swelling or permanent damage to their brain. They can even be fatal. WHAT SHOULD YOU DO IF YOU THINK YOUR ATHLETE HAS A CONCUSSION? If you suspect that an athlete has a concussion, remove the athlete from play and seek medical attention. Do not try to judge the severity of the injury yourself. Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says s/he is symptom-free and it's OK to return to play. Rest is key to helping an athlete recover from a concussion. Exercising or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games, may cause concussion symptoms to reappear or get worse. After a concussion, returning to sports and school is a gradual process that should be carefully managed and monitored by a health care professional. It's better to miss one game than the whole season. For more information on concussions, visit: Student-Athlete Name Printed Student-Athlete Signature Date Parent or Legal Guardian Printed Parent or Legal Guardian Signature Date
14 CONMOCION CEREBRAL EN EL DEPORTE AVENEL Hoja informativa para los deportistas y sus padres acerca de las conmociones cerebrales Una conmoci6n es un tipo de lesion cerebral traumatica que ocasiona cambios en la forma en que funciona el cerebro normalmente. Una conmoci6n es causada por un golpe, impacto o sacudida en la cabeza o el cuerpo que hace que la cabeza y el cerebro se muevan rapida y repentinamente hacia adelante y hacia atrds. Hasta un "chichoncito" o lo que pareciera ser tan solo un golpe o una sacudida leve en la cabeza pueden ser algo grave. LCUALES SON LOS SIGNOS Y SINTOMAS DE UNA CON MOCION CEREBRAL? Los signos y sintomas de una conmocion cerebral pueden aparecer justo despues de una lesion o puede que no aparezcan o se noten sino hasta dias o semanas despues de ocurrida la lesion. Si un deportista presenta uno o mas de los sintonnas de una conmocion cerebral indicados a continuaci6n, zsabia usted que...? La mayoria de las conmociones cerebrales ocurren sin perdida del conocimiento. Los deportistas que han sufrido una conmocion cerebral en algun momento de sus vidas, tienen un mayor riesgo de sufrir otra. Los nilios pequenos y los adolescentes tienen más probabilidad de sufrir una conmocion cerebral y de que les tome más tiempo recuperarse que los adultos. luego de un golpe, impacto o sacudida en la cabeza o el cuerpo, no se le debe permitir continuar jugando el clia de la lesion y no debe volver a jugar hasta que un profesional medico con experiencia en evaluacion de conmociones cerebrales indique que ya no presenta sintomas y que puede volver a jugar. SIGNOS OBSERVADOS POR EL PERSONAL DE ENTRENAMIENTO Parece aturdido o desorientado Esta confundido en cuanto a su posicion de juego Olvida las instrucciones No esta seguro del juego, de la puntuacion o de adversarios Se mueve con torpeza Responde a las preguntas con lentitud Pierde el conocimiento (aunque sea por poco tiempo) Muestra cambios de Mimi comportamiento o personalidad No puede recordar lo ocurrido antes del golpe o caida No puede recordar lo ocurrido despues del golpe o caida SINTOMAS REPORTADOS POR LOS DEPORTISTAS Dolor de cabeza o "presion" en la cabeza Nauseas o vomitos Problemas de equilibrio o mareo Vision borrosa o doble Sensibilidad a la luz Sensibilidad al ruido Sentirse debil, desorientado, aturdido, atontado o grogui Problemas de concentraci6n o de memoria Confusi6n No "sentirse bien" o "con ganas de no hacer nada"
15 SIGNOS DE PELIGRO POR UNA CON MOCION CEREBRAL En casos poco frecuentes, en las personas que sufren una conmocion cerebral puede formarse un coagulo de sangre peligroso que podria hacer que el cerebro ejerza presion contra el crane. Un deportista debe recibir atencion medica de inmediato si luego de sufrir un golpe, impacto o sacudida en la cabeza o el cuerpo presenta alguno de los siguientes signos de peligro: Una pupila esta más grande que la otra Esta mareado o no se puede despertar Dolor de cabeza que es persistente y adernas empeora Debilidad, entumecimiento o menor coordinaci6n Nauseas o vonnitos constantes Dificultad para hablar o pronunciar las palabras Convulsiones o ataques No puede reconocer a personas o lugares Se siente cada vez más confundido, inquieto o agitado Se comporta de manera poco usual Pierde el conocimiento (las perdidas del conocimiento deben considerarse como algo seri aunque sean breves) zpor QUE DEBE UN DEPORTISTA NOTIFICAR A ALGUIEN SI TIENE SiNTOMAS? Si un deportista sufre una conmoci6n, su cerebro necesitara tiempo para sanar. Cuando el cerebro de un deportista se esta curando, tiene una mayor probabilidad de sufrir una segunda conmocion. Las conmociones repetidas (o secundarias) pueden aumentar el tiempo que toma la recuperacion. En casos poco frecuentes, repetidas conmociones Recuerde Las conmociones cerebrales afectan a las personas de manera diferente. Si bien la mayoria de los deportistas que sufren una conmoci6n cerebral se recuperan en forma completa y rapida, algunos tienen sintomas que duran dias o incluso semanas. Una conmocion cerebral más grave puede durar par meses o aim más. cerebrales en los jovenes deportistas pueden ocasionar inflamacian del cerebro o dalio cerebral permanente. Incluso pueden ser mortales. zque DEBE HACER SI CREE QUE SU DEPORTISTA HA SUFRIDO UNA CON MOCION CEREBRAL? Si considera que un deportista tiene una conmoci6n cerebral, saquelo del juego y busque atenci6n medica de inmediato. No intente juzgar usted mismo la seriedad de la lesion. No permita que el deportista regrese a jugar el mismo dia de la lesion y espere a que un profesional medico con experiencia en la evaluacion de conmociones cerebrales indique que ya no presenta sintomas y que puede volver a jugar. El descanso es la cave para ayudar a un deportista a recuperarse despues de una conmoci6n cerebral. Durante el ejercicio o las actividades que requieran de mucha concentraci6n, coma estudiar, trabajar en la computadora o los juegos de video, pueden causar que los sintonnas de la conmoci6n cerebral reaparezcan o empeoren. Despues de una conmocion cerebral, volver a practicar deportes y regresar a la escuela debe ser un proceso gradual que tiene que ser controlado y observado cuidadosamente par un profesional medico. Mejor perder un juego que toda la temporada. Para más informaci6n sabre la conmoci6n cerebral, visite: Nombre del estudiante o deportista Firma del estudiante o deportista Fecha Nombre del padre o tutor legal Firma del padre o tutor legal Fecha VersiOn en espatiol aprobada por CDC Multilingual Services - Order #