POSSIBLE CONCUSSION OR HEAD INJURY NOTIFICATION
In accordance with Florida Statute 943.0438, this is to notify you that should your child receive a possible concussion or head injury during practice or competition. Under Florida law, this player must be removed from play or practice. Before the player may return to practice or competition a written medical clearance to return stating that the youth athlete no longer exhibits signs, symptoms, or behaviors consistent with a concussion or other head injury must be received from an appropriate health care professional trained in the diagnosis, evaluation, and management of concussions. In Florida, an appropriate health-care professional (AHCP) is defined as either a licensed physician (MD, as per Chapter 458, Florida Statutes), a licensed osteopathic physician (DO, as per Chapter 459, Florida Statutes), a licensed physician assistant under the supervision of a MD/DO (as per Chapters 458.347 and 459.022, Florida Statutes) or health care professional trained in the management on concussions. Symptoms that were observed are checked below:
- Dazed look or confusion about what happened.
- Memory difficulties.
- Neck pain, headaches, nausea, vomiting, double vision, blurriness, ringing noise or sensitivity to sounds.
- Short attention span- Cannot keep focused.
- Slow reaction time, slurred speech, bodily movements are lagging, fatigue and slowly answers questions or have difficulty answering questions.
- Abnormal physical and/or mental behavior Coordination skills are behind; ex: balancing, dizziness, clumsiness, reaction time.
Please take the necessary precautions and seek an appropriate medical professional. Until a professional medical opinion in provided, please consider the following guidelines:
- Refrain from participation in any activities the day of, and the day after, the occurrence.
- Refrain from taking any medicine unless (1) current medicine, prescribed or authorized, is permitted to be continued to be taken, and (2) any other medicine is prescribed by a licensed health care professional.
PLAYER WAIVER OF LIABILITY
I, as the undersigned Parent or Guardian, do hereby willfully acknowledge that my signature below attests to my understanding that my child shall participate in recreational soccer practices and games, and in agreement that soccer is a physical, contact sport that involves the risk of injury. I assume all risks and hazards associated with my child participating in the sport. I acknowledge that my child is in proper physical condition to participate in soccer practices and games and has/have no illness, disease or pre-existing injury or physical defect that would be aggravated by their participation, or that I have advised in writing the authorities of the Soccer Communities of America of said condition, including my physician’s name, and confirm the ability of the named Registrant to participate regardless.
I further acknowledge that this risk may involve personal injury or loss or damage to me, my child or my property, including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency medical care.
I, the Parent or Guardian of the Registrant, authorize the Real Madrid Foundation and International Studies Foundation, its volunteers, employees, or representatives to act as my agent(s) to consent to medical, surgical or dental examination and/or treatment at a hospital or other health facility in an emergency where I can not be reached.
I, the Parent/Guardian hereby release and discharge Real Madrid Foundation, International Studies Foundation, the City of Miami Parks, the State of Florida, its agents, employees, and officers, from all claims, demands, actions, judgments and executions which the undersigned ever had, or now has, or may have, or which the undersigned’s heirs, executors, or assigns may have, or claim to have, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by or arising out of, the described activity.
I, the Parent/Guardian hereby give my permission for my child to participate in the above described activity. I voluntarily execute this waiver liability with full knowledge of its content. My signature attests to this on behalf of myself and my executors, personal representatives, administrators, heirs, next-of-kin, successors, and assigns.
I, Parent/Guardian agree to the above terms and conditions. Sign and print your name below.
