Participation Release Form

Hello Region 87 Coaches,

Many of you will not have need of the below AYSO participation release form. However, to the few that do..., we want to make sure you have the tools and knowledge at your use. Please see the notes below on the Participation Release Form guidelines (and participation release form link at the bottom). This should be completed prior to any player returning to practice or playing after a concussion or an injury or illness that required the care of a physician or a visit to an emergency care facility per the AYSO guidelines. Thank you for all you do! You are great!!!

 

AYSO Participation Release Form:  Whenever a player or youth volunteer has suffered a concussion or an injury or illness that required the care of a physician or a visit to an emergency care facility, the AYSO Participation Release Form must be given to the parents or guardians. The participation release form must be completed in full and signed by the child¹s parents or guardians before the player or youth volunteer will be allowed to participate further in the program. This form protects not only AYSO, but more importantly, the participants. Too often participants are out playing again before they are physically ready. Players should not participate until they are ready to play again. This form should also be used in cases of major illness.

 

Directions for use:

 

  1. The Regional Safety Director should enter the mailing information located in the lower portion of the form on a master copy of the form each year, and prepare copies for distribution or make the form downloadable from the Region's web site.

  2. One or several blank forms should be given to all team coaches as part of the materials provided them at the beginning of any season.

  3. Tournament directors would be advised to have a supply on hand as well.

  4. he form should be sent to the Regional Safety Director for filing, but could be retained by the coach for a week or so in the event anyone might question the participation of the player subsequent to an illness or injury. (At the Region's option a two part NCR version of the form could be produced so that the coach retains a copy and sends the original to the Regional Safety Director.)

  5. The form is required whenever a player is removed from participation for concussion symptoms or it is known that the player has had to seek emergency room treatment or a physician office visit to treat an injury or illness affecting the player's readiness to participate.

  6. Participation Release Forms for a Concussion and any accompanying Medical Release required by State law, must be forwarded to the National Office at insurance@ayso.org.

 

Copy of Participation Release Form