Get the free ImPACT Concussion Management Program Permission Slip

This document provides information regarding the ImPACT concussion management program for student-athletes at Bayard Rustin High School and includes a permission slip for parents to authorize their

How to fill out impact concussion management program

How to fill out ImPACT Concussion Management Program Permission Slip

1. Start by downloading the ImPACT Concussion Management Program Permission Slip from the official website or your school's athletic department.
2. Read through the document carefully to understand the information being required.
3. Fill in the athlete's full name at the top of the slip.
4. Provide the date of birth and age of the athlete.
5. Include the name of the parent or guardian who will be signing the slip.
6. Fill in the contact information, including phone numbers and email addresses, for the parent/guardian.
7. Review the consent section thoroughly and ensure all necessary information regarding risks and responsibilities is understood.
8. Sign and date the permission slip where indicated to acknowledge consent.
9. Submit the completed permission slip to the appropriate school or team official.

Who needs ImPACT Concussion Management Program Permission Slip?

1. Any athlete participating in sports programs where the ImPACT Concussion Management Program is implemented requires this permission slip from a parent or guardian.

People Also Ask about

What is the ImPACT assessment for a concussion?

What Is an ImPACT Evaluation? An Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) evaluation is a 20- to 30-minute computer-based test that helps measure multiple aspects of cognitive function, such as: Attention span.

What are the 3 R's of concussion management?

Three R's of Concussion Management: Return-to-School, Return-to-Learn, and Return-to-Play.

What are the 4 P's of concussion?

You can conserve energy by using the “Four P's” principle: Prioritize, Plan, Pace, and Position.

How to document a concussion?

Obtain description of the injury - how injury occurred, type of force, location on the head or body if force transmitted to head. Different biomechanics of injury may result in differential symptom patterns (e.g., occipital may result in visual changes, balance difficulties). 2. Indicate the cause of injury.

What are the 4 R's of concussion management in NRL?

REMEMBER 'THE 4 RS' Recognise the signs and symptoms. Remove the player from play. Recover fully before returning to sport. Return - only after following a Graduated Return to Play.

What are the 4 R's for concussion?

The principles of concussion management in English rugby are summarised by the 4R's - RECOGNISE, REMOVE, RECOVER and RETURN. These principles have been designed to minimise the risk of short, medium and long-term harm to the brain.

What is the Phase 4 concussion protocol?

Phase 4, non-contact training drills: The player can continue cardiovascular, strength and balance training, team-based sports-specific exercise and participate in non-contact football activities.

What are the 4 R's of concussion management?

REMEMBER 'THE 4 RS' Recognise the signs and symptoms. Remove the player from play. Recover fully before returning to sport. Return - only after following a Graduated Return to Play.

For pdfFiller’s FAQs

What is ImPACT Concussion Management Program Permission Slip?

The ImPACT Concussion Management Program Permission Slip is a form that allows parents or guardians to grant permission for their child to participate in the ImPACT program, which is designed for assessing and managing concussions in youth sports.

Who is required to file ImPACT Concussion Management Program Permission Slip?

Parents or guardians of student-athletes who wish to participate in the ImPACT Concussion Management Program are required to file the permission slip.

How to fill out ImPACT Concussion Management Program Permission Slip?

To fill out the ImPACT Concussion Management Program Permission Slip, parents or guardians need to provide their child's information, such as name and date of birth, as well as sign and date the form to acknowledge their consent for participation.

What is the purpose of ImPACT Concussion Management Program Permission Slip?

The purpose of the ImPACT Concussion Management Program Permission Slip is to ensure that parents or guardians are informed about the program and consent to their child's participation in concussion evaluation and management.

What information must be reported on ImPACT Concussion Management Program Permission Slip?

The information that must be reported on the ImPACT Concussion Management Program Permission Slip includes the student's name, date of birth, insurance details, emergency contact information, and the signature of the parent or guardian providing permission.