Parent Form

AJAX UTAH FC PARENTAL CONSENT FORM

I am a parent or legal guardian of the named minor. I fully understand that participating in the sport of soccer presents a risk for serious injury and death. In my capacity as parent or legal guardian, I understand the risks and my responsibility to notify the other parent or legal guardians as well as the minor of the risks involved with sport participation. I have made a conscious decision to allow the named minor to play. I agree that my health and accident insurance will be the primary insurance to cover expenses for any such injury, including rehabilitation. 

 

As parent or legal guardian of the above-named registrant, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are deemed necessary to preserve the life, limb, or well-being of the registrant.

 

This Parent Code of Conduct has been developed to clarify and define the standards of professional, ethical, and moral behavior from parents affiliated with the Utah Youth Soccer Association (UYSA). 1. I will emphasize that the game is played for fun, and for the benefit of the youth, not adults. 2. I will act as a role model by demonstrating positive support for all players, coaches, and game officials regardless of race, creed, color, gender, religion, or ability. 3. I will not engage in any kind of unsportsmanlike conduct with any official, coach, player, parent, or spectator such as booing and taunting, refusing to shake hands, or using profane language or gestures. 4. I will teach my child to play within the spirit and intentions of the rules and the Laws of the Game. 5. I will refrain from criticizing the game officials, and will respect their authority and decisions during games. 6. I will never place the value of winning over the safety and welfare of the players. 7. I will demand a sports environment free from drugs, tobacco, and alcohol and I will refrain from their use at all sporting events. 8. I will not encourage, invite, nor recruit any player from an opposing team to join my childs team during the playing season. I understand that there are no refunds for any reason.  I understand that if I fail to abide by the aforementioned UYSA Parent Code of Conduct, I will be subject to disciplinary action that could include, but is not limited to the following: Verbal warning by an official, team coach, and/or head of league organization - Game forfeiture through an official or team coach - Parental suspension with written documentation to be kept on file with UYSA I have read this UYSA Parent Code of Conduct. I understand its requirements and agree to abide by the letter and spirit of this UYSA Parent Code of Conduct.

 

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 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. Symptoms may include one or more of the following:

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

What can happen if my child keeps on playing with a concussion or returns to soon? 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 suffered 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 H.B. 204 in Utah 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, its 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/concussion/HeadsUp/youth.html  

 

 

Signature ________________________

 

PRINT