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PLAYER INFORMATION

PARENT/GUARDIAN #1

PARENT/GUARDIAN #2

MEDICAL/EMERGENCY CONTACT INFORMATION
Consent for Emergency Medical Treatment


In the event of an emergency or non-emergency situation requiring medical treatment, including accidental injury or illness, I hereby grant permission for any and all medical and/or dental treatment to be administered to my child, until such time as I am able to be contacted. This permission includes, but is not limited to, the administration of first aid, the use of an ambulance, and the administration of anesthesia and /or surgery, under the recommendation of qualified medical personnel.

PARENT/GUARDIAN AGREEMENT
I understand that as a parent/guardian of a child playing for Bethel Diamond Sports, Inc. I am a member of the organization. I am encouraged to attend meetings and vote on general issues and the election of directors. I am encouraged to assist the organization and my child’s coach to the best of my ability. I understand that I have the opportunity to be nominated and elected as a director or appointed as an officer. Notice of meetings will be posted on the Bethel Diamond Sports, Inc. website. (betheldiamondsports.com)

I understand that as a member of Bethel Diamond Sports, Inc., both my child and I are expected to obey all the rules of the organization, and all league rules, during practices, games, and other organizational activities. I understand that if my child or I fail to abide by these rules, my child and I are subject to the disciplinary process as set forth in the Regulations. A copy of the Regulations is available on the Bethel Diamond Sports, Inc. website. (betheldiamondsports.com)

I acknowledge that my child may be injured while playing baseball and/or softball. I agree that Bethel Diamond Sports, Inc., its members, coaches, officers, and directors, or its affiliated organizations and leagues, and any entity whose facilities are used, shall not be held liable for any injury or loss which my child may sustain while participating in activities of any kind (including games, practices, and travel to and from these activities), whether sponsored by or under the supervision of Bethel Diamond Sports, Inc. I also agree that, to the fullest extent of the law, I will indemnify and hold harmless Bethel Diamond Sports, Inc., its members, coaches, officers, directors, any affiliated organizations, or any entity whose facilities are used from any claim whatsoever.

LINDSAY'S LAW PARENT INFORMATION SHEET
Sudden Cardiac Arrest and Lindsay's Law
Parent/Athlete Signature Form
What is Lindsay's Law? Lindsay's Law is about Sudden Cardiac Arrest (SCA) in youth athletes. It covers all athletes 19 years or younger who practice for or compete in athletic activities. Activities may be organized by a school or youth sports organization.
Which youth athletic activities are included in Lindsay's law?
-Athletics at all schools in Ohio (public and non-public)
-Any athletic contest or competition sponsored by or associated with a school
-All interscholastic athletics, including all practices, interschool practices and scrimmages
-All youth sports organizations
-All cheerleading and club sports, including noncompetitive cheerleading
What is SCA? SCA is when the heart stops beating suddenly and unexpectedly. This cuts off blood flow to the brain and other vital organs. People with SCA will die if not treated immediately. SCA can be caused by 1) a structural issue with the heart, OR 2) a heart electrical problem which controls the heartbeat, OR 3) a situation such as a person who is hit in the chest or a gets a heart infection.
What is a warning sign for SCA? If a family member died suddenly before age 50, or a family member has cardiomyopathy, long QT syndrome, Marfan syndrome or other rhythm problems of the heart.
What symptoms are a warning sign of SCA? A young athlete may have these things with exercise:
-Chest pain/discomfort
-Unexplained fainting/near fainting or dizziness
-Unexplained tiredness, shortness of breath or difficulty breathing
-Unusually fast or racing heart beats
What happens if an athlete experiences syncope or fainting before, during or after a practice, scrimmage, or competitive play? The coach MUST remove the youth athlete from activity immediately. The youth athlete MUST be seen and cleared by a health care provider before returning to activity. This written clearance must be shared with a school or sports official.
What happens if an athlete experiences any other warning signs of SCA? The youth athlete should be seen by a health care professional.
Who can evaluate and clear youth athletes? A physician (MD or DO), a certified nurse practitioner, a clinical nurse specialist, certified nurse midwife. For school athletes, a physician's assistant or licensed athletic trainer may also clear a student. That person may refer the youth to another health care provider for further evaluation.
What is needed for the youth athlete to return to the activity? There must be clearance from the health care provider in writing. This must be given to the coach and school or sports official before return to activity.
All youth athletes and their parents/guardians must view the Ohio Department of Health (ODH) video about Sudden Cardiac Arrest, review the ODH SCA handout and then sign and return this form.

CONCUSSION INFORMATION SHEET
Ohio Department of Health Concussion Information Sheet For Youth Sports Organizations
Dear Parent/Guardian and Athletes,
This information sheet is provided to assist you and your child in recognizing the signs and symptoms of a concussion. Every athlete is different and responds to a brain injury differently, so seek medical attention if you suspect your child has a concussion. Once a concussion occurs, it is very important your athlete return to normal activities slowly, so he/she does not do more damage to his/her brain.

What is a Concussion?
A concussion is an injury to the brain that may be caused by a blow, bump, or jolt to the head. Concussions may also happen after a fall or hit that jars the brain. A blow elsewhere on the body can cause a concussion even if an athlete does not hit his/her head directly. Concussions can range from mild to severe, and athletes can get a concussion even if they are wearing a helmet.
Signs and Symptoms of a Concussion
Athletes do not have to be knocked out? to have a concussion. In fact, less than 1 out of 10 concussions result in loss of consciousness. Concussion symptoms can develop right away or up to 48 hours after the injury. Ignoring any signs or symptoms of a concussion puts your child's health at risk!
Signs Observed by Parents of Guardians
♦ Appears dazed or stunned.
♦ Is confused about assignment or position.
♦ Forgets plays.
♦ Is unsure of game, score or opponent.
♦ Moves clumsily.
♦ Answers questions slowly.
♦ Loses consciousness (even briefly).
♦ Shows behavior or personality changes (irritability, sadness, nervousness, feeling more emotional).
♦ Can't recall events before or after hit or fall.
Symptoms Reported by Athlete
♦ Any headache or pressure in head. (How badly it hurts does not matter.)
♦ Nausea or vomiting.
♦ Balance problems or dizziness.
♦ Double or blurry vision.
♦ Sensitivity to light and/or noise
♦ Feeling sluggish, hazy, foggy or groggy.
♦ Concentration or memory problems.
♦ Confusion.
♦ Does not feel right.
♦ Trouble falling asleep.
♦ Sleeping more or less than usual.

Be Honest
Encourage your athlete to be honest with you, his/her coach and your health care provider about his/her symptoms. Many young athletes get caught up in the moment and/or feel pressured to return to sports before they are ready. It is better to miss one game than the entire season? or risk permanent damage!
Seek Medical Attention Right Away
Seeking medical attention is an important first step if you suspect or are told your child has a concussion. A qualified health care professional will be able to determine how serious the concussion is and when it is safe for your child to return to sports and other daily activities.
♦ No athlete should return to activity on the same day he/she gets a concussion.
♦ Athletes should NEVER return to practices/games if they still have ANY symptoms.
♦ Parents and coaches should never pressure any athlete to return to play.
The Dangers of Returning Too Soon
Returning to play too early may cause Second Impact Syndrome (SIS) or Post-Concussion Syndrome (PCS). SIS occurs when a second blow to the head happens
before an athlete has completely recovered from a concussion. This second impact causes the brain to swell, possibly resulting in brain damage, paralysis, and even death. PCS can occur after a second impact. PCS can result in permanent, long-term concussion symptoms. The risk of SIS and PCS is the reason why no athlete should be allowed to participate in any physical activity before they are cleared by a qualified health care professional.
Recovery
A concussion can affect school, work, and sports. Along with coaches and teachers, the school nurse, athletic trainer, employer, and other school administrators should be aware of the athlete's injury and their roles in helping the child recover.
During the recovery time after a concussion, physical and mental rest are required. A concussion upsets the way the brain normally works and causes it to work longer and harder to complete even simple tasks. Activities that require concentration and focus may make symptoms worse and cause the brain to heal slower. Studies show that children's brains take several weeks to heal following a concussion.
http://www.healthy.ohio.gov/vipp/child/returntoplay/concussion
Rev. 09.16
Returning to Daily Activities
1. Be sure your child gets plenty of rest and enough sleep at night? no late nights. Keep the same bedtime weekdays and weekends.
2. Encourage daytime naps or rest breaks when your child feels tired or worn-out.
3. Limit your child's activities that require a lot of thinking or concentration (including social activities,
homework, video games, texting, computer, driving, job‐related activities, movies, parties). These activities can slow the brain's recovery.
4. Limit your child's physical activity, especially those activities where another injury or blow to the head may occur.
5. Have your qualified health care professional check your child?s symptoms at different times to help guide recovery.

Returning to Learn (School)
1. Your athlete may need to initially return to school on a limited basis, for example for only half-days, at first. This should be done under the supervision of a qualified health care professional.
2. Inform teacher(s), school counselor or administrator(s) about the injury and symptoms. School personnel should be instructed to watch for:
a. Increased problems paying attention.
b. Increased problems remembering or learning new information.
c. Longer time needed to complete tasks or assignments. d. Greater irritability and decreased ability to cope with stress.
e. Symptoms worsen (headache, tiredness) when doing schoolwork.
3. Be sure your child takes multiple breaks during study time and watch for worsening of symptoms.
4. If your child is still having concussion symptoms, he/ she may need extra help with school‐related activities. As the symptoms decrease during recovery, the extra help or supports can be removed gradually.
5. For more information, please refer to Return to Learn at http://www.healthy.ohio.gov/vipp/concussion.aspx
Resources
ODH Violence and Injury Prevention Program
http://www.healthy.ohio.gov/vipp/concussion.aspx
Centers for Disease Control and Prevention
http://www.cdc.gov/headsup/basics/index.html

National Federation of State High School Associations
www.nfhs.org
Brain Injury Association of America
www.biausa.org/
Returning to Play
1. Returning to play is specific for each person, depending on the sport. Starting 4/26/13, Ohio law requires written permission from a health care provider before an athlete can return to play. Follow instructions and guidance provided by a health care professional. It is important that you, your child and your child's coach follow these instructions carefully.
2. Your child should NEVER return to play if he/she still has ANY symptoms. (Be sure that your child does not have any symptoms at rest and while doing any physical activity and/or activities that require a lot of thinking or concentration).
3. Ohio law prohibits your child from returning to a game or practice on the same day he/she was removed.
4. Be sure that the athletic trainer, coach and physical education teacher are aware of your child's injury and symptoms.
5. Your athlete should complete a step-by-step exercise -based progression, under the direction of a qualified healthcare professional.
6. A sample activity progression is listed below. Generally, each step should take no less than 24 hours so that your child's full recovery would take about one week once they have no symptoms at rest and with moderate exercise. *
Sample Activity Progression*
Step 1: Low levels of non-contact physical activity, provided NO SYMPTOMS return during or after activity. (Examples: walking, light jogging, and easy stationary biking for 20‐30 minutes).
Step 2: Moderate, non-contact physical activity, provided NO SYMPTOMS return during or after activity. (Examples: moderate jogging, brief sprint running, moderate stationary biking, light calisthenics, and sport‐ specific drills without contact or collisions for 30‐45 minutes).
Step 3: Heavy, non‐contact physical activity, provided NO SYMPTOMS return during or after activity. (Examples: extensive sprint running, high intensity stationary biking, resistance exercise with machines and free weights, more intense non‐contact sports specific drills, agility training and jumping drills for 45‐60 minutes).
Step 4: Full contact in controlled practice or scrimmage. Step 5: Full contact in game play.
Ohio Department of Health
Violence and Injury
Prevention Program
246 North High Street, 5th Floor
Columbus, OH 43215
(614) 466-2144
http://www.healthy.ohio.gov/vipp/child/returntoplay/concussion Rev. 09.16

 

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