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BELLPORT YOUTH LACROSSE
PARENT ACKNOWLEDGEMENT OF CONCUSSION POLICY

 
Lacrosse is a sport with obvious risks. Players can be injured during games, practices, or drills. Most injuries are minor but others are not. Concussions are one such injury that the Bellport Youth Lacrosse holds in serious regard. 
 
A concussion occurs anytime there is injury to the head. Symptoms (including but not limited to loss of consciousness, nausea, headache, dizziness, trouble with vision or memory, confusion, light or sound sensitivity) may occur immediately or days afterwards. Most of the time, a concussion does completely resolve with time. However, if the player receives a second concussion while they are still healing from the first injury, permanent neurological damage may occur.
 
If your child suffers an injury suspicious of a concussion, we have directed our coaching staff to remove them immediately from the game or practice. Your child may not return to action until he/she is cleared to play lacrosse by a physician. A signed and dated note stating their clearance is to be provided to the player’s head coach (who must submit the note to the League Secretary). 
 
This policy is obviously done to protect the safety of each player. Please sign below indicating you have read, understand and agree with the Bellport Youth Lacrosse Concussion/Severe Injury Policy. 
 
Player Name: ________________    Grade: _______
 
Player Name: ________________    Grade: _______
 
Player Name: ________________    Grade: _______
 
Player Name: ________________    Grade: _______
 
 
Parent Signature: ________________________  Date: ______
 
Parent Name (printed): _______________________________
 
 
Revised 9/10