Consent & Concussion Form

L&L Sports Waiver

By checking this box and typing my name below, I agree to the following agreement:

In consideration of the services of L and L Sports, , Inc. their members, agents, officers, volunteers, participants, employees, and all other persons or entities acting in capacity on their behalf (hereinafter collectively referred to as “L AND L SPORTS, ”), I do hereby agree to release and discharge L AND L SPORTS, , on behalf of myself, my children,
my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that the game of basketball entails known and unanticipated risks which could result in physical or emotional injury, paralysis, death or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
The risks include, among other things: Collision with fans and other participants, the walls or other fixed objects; falling down; my own equipment failure or the failure of other’s equipment; my own or other’s negligence; objects or conditions on the gym floor surface that may cause me to fall; break bones; sprains; head, neck and back injuries;
abrasions; and bruises or even death.
Furthermore, L AND L SPORTS, volunteers have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant’s fitness, abilities or limitations. They may give inadequate warnings or instructions, and the equipment being used might malfunction.
2. I expressly agree and promise to accept and assume all of the risk in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to indemnity and hold harmless L AND L SPORTS, from any and all claims, demands, or causes of action, which are in any way connected with my participation
in this activity or my use of L AND L SPORTS, and all rented facilities equipment or facilities, including such claims which allege negligent acts or omission of L AND L SPORTS, .
4. Should L AND L SPORTS, or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnity and hold harmless for all such fees and costs.
5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage to myself. I further certify that I have no medical
or physical conditions which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs – of all risks that may be created, directly or indirectly, by any such condition.
6. In the event that I file a lawsuit against L AND L SPORTS, , I agree to do so solely in the state of Wisconsin, and I further agree that the substantive law of that state shall apply in this action without regard to the conflict of law rules of that state.
7. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portion shall remain in full force and effect.
By signing this document, I agree that if anyone hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against L AND L SPORTS, on the basis of any claim from which I have released them herein.
I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Player Name *

Team Name *

Grade *

Gender *MaleFemale

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Date *

Parent/Guardian Name *

Parent/Guardian Email Address *

Parent/Guardian Phone *

Date *

Concussion Waiver

By checking the box above I confirm that I have read and agree to the following:

A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can
take hours or days to fully appear. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.

What can happen if my child keeps on playing with a concussion or returns too soon?

Symptoms may include one or more of the following:

Headaches
Amnesia
“Pressure in head”
“Don’t feel right”
Nausea or vomiting
Fatigue or low energy
Neck pain
Sadness
Balance problems or dizziness
Nervousness or anxiety
Blurred, double, or fuzzy vision
Irritability
Sensitivity to light or noise
More emotional
Feeling sluggish or slowed down
Confusion
Feeling foggy or groggy
Concentration or memory problems
Drowsiness (forgetting game plays)
Change in sleep patterns
Repeating the same question/comment

Signs observed by teammates, parents and coaches include:

Appears dazed
Vacant facial expression
Confused about assignment
Forgets plays
Is unsure of game, score, or opponent
Moves clumsily or displays in coordination
Answers questions slowly
Slurred speech
Shows behavior or personality changes
Can’t recall events prior to hit
Can’t recall events after hit
Seizures or convulsions
Any change in typical behavior or personality
Loses consciousness

Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athlete will often under report symptoms of injuries. And concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student athlete’s safety.

If you think your child has had a concussion:
Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. The new “Zackery Lystedt Law” in Washington now requires the consistent and uniform implementation of long and well-established return to play concussion guidelines that have been recommended for several years:
“a youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time”

And

“...may not return to play until the athlete is evaluated by a licensed heath care provider trained in the evaluation and management of concussion and received written clearance to return to play from that health care provider”.

You should also inform your child’s coach if you think that your child may have a concussion. Remember, it’s better to miss one game than miss the whole season. And when in doubt, the athlete sits out.
For current and up-to-date information on concussions you can go to:
http://www.cdc.gov/ConcussionInYouthSports/

Player Name *

Date *

Parent/Guardian Name *

Date *

L&L Sports Waiver

Concussion Waiver

List of Waivers Submitted Below: