Hawaii's official youth lacrosse league, AYLA is a member of US Lacrosse with teams in age groups from kindergarten through high school. This is a volunteer run organization.






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Parent notified via:

Phone  _____   In-person ______ Other (please specify)

Your son/daughter was suspected of having a concussion on:



Description of injury event



Initial symptoms observed

Dazed or “glassy eyes”

Confused or disoriented


Loss of balance or clumsiness

Difficulty following directions


Loss of consciousness

More emotional


Other: _______________________________________________________________________________________


Symptoms Reported




Low energy

Difficulty remembering

Difficulty concentrating

Visual problem

Sensitivity to light

Sensitivity to noise



Other: _______________________________________________________________________________________


If you notice the following, call 911 or take your child to the ER:

Difficulty Breathing

Decreased level of consciousness

Increase intensity of headaches

Unequal, dilated, unreactive pupils

Mental status changes


Neck Pain



Parent Information Checklist:

  • Take your child to your physician for follow up care.
  • During the first 24-72 hours, limit cognitive stimulation such as texting, video games, computer use, reading, and writing.
  • No practice, games, or physical activity until advised or cleared by a physician.
  • Call the school’s front office, counselor, or student services coordinator to let the school know that your child has a concussion.
  • 8 to 10 hours of continuous sleep at night is recommended.  Avoid frequent napping.
  • Must have a medical clearance from a licensed health care provider before your child may return to practice or play.