Concussion Waiver Acknowledg​ement


I hereby consent to participation in a Florida Lacrosse League, Inc. (“FLL”) sponsored event. I consent and grant permission to FLL Program Administrator, Directors, Officers, Coaches, Assistant Coaches and/or volunteers, or any other Florida Lacrosse League, Inc. official, to obtain any medical care necessary as a result of injuries sustained by my child during my child’s participation in this activity.


I understand that in order to participate, I must be a current Member of US Lacrosse. I hereby certify that I am a current member of US Lacrosse with the Membership Number set forth above, with such membership expiring as of the date set forth above.


In consideration of my child’s being allowed to participate in any way in FLL programs, the undersigned parent(s) or legal guardian(s):  (1) Agree to instruct the minor participant that prior to participating, she should inspect the facilities and equipment to be used, and if the participant believes that anything is unsafe, she should immediately advise her coach or supervisor of such conditions and refuse to participate. (2) Acknowledge and fully understand that each participant engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which may result not only from their own action, inaction, or negligence, but action, inaction, or negligence of others, the rules of play, or condition of the premises or any equipment used. Further, that there may be other risks not known or reasonably foreseeable at this time. (3) Assume all of the above risks and accept full personal responsibility for the damages following any such injury, permanent disability, or death. (4) Release, waive, discharge, and promise not to sue and otherwise agree to hold harmless South Tampa Sticks Youth Lacrosse League, Inc., as well as its directors, officers, sponsors, managers, coaches, participants, volunteers, and others associated with South Tampa Sticks Youth Lacrosse League, Inc. and the owners/lessor of premises used to conduct the events and their respective governing bodies, elected officials, directors, officers, employees and/o agents from any and all liability for injuries, damages, disability, or death sustained during my participation in any aspect of this activity. (5) Agree that my participation in FLL shall be subject to the policies and rules adopted from time to time by FLL, as well as the US Lacrosse Council Code of Conduct, a copy of which may be obtained by visiting the US Lacrosse website at (6) Acknowledge that my child and I are responsible for the purchase of all protective and other equipment necessary for my child’s participation including without limitation crosse, goggles or face cage, mouthpiece and shoes for girls; throat guard and chest protectors for goalies. South Tampa Sticks Youth Lacrosse League, Inc., its directors, officers, sponsors, managers, coaches, participants, volunteers, and others associated with South Tampa Sticks Youth Lacrosse League, Inc Club shall have no liability or responsibility for the condition of any equipment used by my child or any defect with respect thereto or as the result of any injury, damage, disability or death arising therefrom.


Section 943.0438(f) of the Florida Statutes requires that Florida Lacrosse League, Inc. maintain a policy of requiring the participating in athletic competition or who is a candidate for an athletic team to sign and return an informed consent that explains the nature and risk of concussion and head injury each year before participating in athletic competition or engaging in any clinic, practice, try-out, workout, or other physical activity associated with the youth’s candidacy for an athletic team.

The Facts:

  • A concussion is a brain injury.
  • All concussions are serious.
  • Concussions can occur without the loss of consciousness.
  • Concussions can occur in any sport.
  • Recognition and proper management of concussions when they first occur can help prevent further injury or even death.

What is a concussion? 

A concussion is an injury that changes how the cells in the brain normally work. a concussion is caused by a blow to the head or body which causes the brain to move rapidly inside the skull. Even a “Ding”, “Getting your bell rung”, or what seems like a mild bump or blow to the head can be serious. Concussions can also result from a fall or players colliding with each other or obstacles, such as a goal post, even if they do not directly hit their head.

To help recognize a concussion, you should watch for the following signs in your athletes:

  1. A forceful blow to the head or body that results in rapid movement of the head and
  2. Any change in the athlete’s behavior, thinking, or physical functioning.

Signs and symptoms of a concussion that may be reported by a coach or other observer:

  • appears dazed or stunned.
  • Is confused about assignment or position.
  • Forgets sports plays.
  • Is unsure of game, score, or opponent.
  • Moves clumsily.
  • answers questions slowly.
  • Loses consciousness (even briefly)
  • Can’t recall events prior to hit or fall.
  • Signs and symptoms that may be reported by the player:
  • A headache or pressure in the head.
  • Nausea or vomiting.
  • Balance problems or dizziness.
  • Double or blurry vision.
  • Sensitivity to light.
  • Sensitivity to noise.
  • Feeling sluggish, hazy, foggy, or groggy.
  • Concentration or memory problems.
  • Confusion.
  • Does not feel right.

Players are advised to take the Center for Disease Control’s free online concussion training at

Under Florida law, a player who is suspected of having a concussion or head injury must be removed from play or practice. Before the player may return to practice or competition a written medical clearance to return stating the 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 licensed physician (MD as provided in Chapter 458, Florida Statutes) a licensed physicians assistant under the supervision of a MD/DO  (as per Chapters 458.347 and 459.022, Florida statutes) or a health care professional trained in the management of concussions.

I, hereby acknowledge and agree to the foregoing consent and waivers and further acknowledge receipt of the foregoing Informed Consent Regarding Concussions and Head Injury and do hereby consent to our child’s or ward’s participation in all programs sponsored by Florida Lacrosse League, Inc.