Region 85 is required by California state law to collect and retain a Concussion Information Sheet for each player.  The Concussion Information Sheet should be reviewed and signed by both the player and parent.

Parents - Please print a copy of the form.  Review the form with your player.  Both Parent and Player sign/date the Concussion Information Sheet.  Return the signed form to your team's Head Coach at your next practice.

Coaches - Collected signed Concussion Information Sheet for each player.  Confirm signed by parent and player.  When all forms have been collected for the team, turn your forms into your Division Coordinator.

Division Coordinators - Collect signed Concussion information Sheets from each team.  Confirm form received for each player.  Turn forms into the Region Safety Director.

IMPORTANT: All signed forms must be on file with the Region Safety Director by Opening Day (first game) on 9/10/2022.

According to the CDC, between 2001 and 2009, an estimated 173,285 people under age 19 were treated in hospital emergency rooms for concussions related to sports and recreation activities.

A concussion is a mild traumatic brain injury (TBI). It can occur after an impact to your head or after a whiplash-type injury that causes your head and brain to shake quickly back and forth. A concussion results in an altered mental state that may include becoming unconscious.

Anyone can become injured during a fall, car accident, or any other daily activity. If you participate in impact sports, you have an increased risk of getting a concussion. Concussions are usually not life-threatening, but they can cause serious symptoms that require medical treatment.

In the event a player is removed from play for a suspected head injury or observed signs/symptoms of a possible concussion, that player cannot return to play for the remainder of the day. The player can only return to AYSO activities (i.e. practice, game, tournament, etc.) with an AYSO Participation Release form signed by the parent or guardian. As mandated by California state law, a medical release must also be provided before the child can return to AYSO activities.

All of these forms, including a copy of the signed Player Registration form, AYSO Incident Form and any Soccer Accident Insurance (SAI) claims forms, must be given to the Region Safety Director. The Region Safety Director will forward completed forms to the National Office.