Forms and Registration Information
Printable Only Forms
Printable PDF's and ADA Compliant Forms
- Student Assurancce Insurance Form
- Heads up Concussion in High School Sports - A Fact Sheet for Athletes
- Know Your Concussion ABC's
Student Assurancce Insurance Form
Student Injuries Can Happen
Medical Expenses Can Be a Financial Hardship When the Unexpected Occurs Approved By Your School/School District - Available for All Students PK-12
- What is Student Accident Insurance?
- Coverage that provides financial assistance with your out-of-pocket medical expenses when your student sustains an accidental bodily injury.
- Why Consider Student Accident Insurance For Your Student?
- High Deductible/Copayments to your Family’s Primary Health Insurance
- No Health Insurance for your Student
- Your Student participates in a interscholastic sport where an unexpected injury is more likely to occur.
- Your Student is prone to injuries
- Coverage Options Available Through Your School
- School Time Coverage - $16.00
- 24-Hour/Full-Time Coverage - $99.00
- Interscholastic Sports Coverage (w/School Time-$91.00 or 24 Hour Coverage-$174.00)
- Football Coverage - $250.00 (Grades 9-12 for the football season)
- Extended Dental Coverage - $9.00
- Premium Paid Once a School Year
To Enroll Your Student & Review Medical Benefits
Go to: www.sas-mn.com
Please locate “K-12 Students & Parents” on our homepage. Within this division, you will be able to search for your student’s school district. Once located, you will have access to the following information: t Purchase Coverage (Managed Online or by Printing/Mailing Enrollment Form and premium)
- Brochure (English & Spanish) (Explains medical benefits, exclusions and coverage options)
- Claim Form ) (fillable form when enrolled student sustains injury)
For Questions, Call Student Assurance Services at (800) 328-2739
Specializing in Student Accident Insurance Since 1971.
The above information is just a brief description of Student Assurance Service’s student accident insurance. For more information including costs, benefits, effective dates, exclusions, limitations, please refer to www.sas-mn.com Students are able to purchase coverage only if his/her school district is a policyholder with the insurance company
Heads up Concussion in High School Sports - A Fact Sheet for Athletes
What is a concussion?
A concussion is a brain injury that:
- Is caused by a bump, blow, or jolt to the head or body.
- Can change the way your brain normally works.
- Can occur during practices or games in any sport or recreational activity.
- Can happen even if you haven’t been knocked out.
- Can be serious even if you’ve just been “dinged” or “had your bell rung.”
All concussions are serious. A concussion can affect your ability to do schoolwork and other activities (such as playing video games, working on a computer, studying, driving, or exercising). Most people with a concussion get better, but it is important to give your brain time to heal.
What are the symptoms of a concussion?
You can’t see a concussion, but you might notice one or more of the symptoms listed below or that you “don’t feel right” soon after, a few days after, or even weeks after the injury.
- Headache or “pressure” in head
- Nausea or vomiting
- Balance problems or dizziness
- Double or blurry vision
- Bothered by light or noise
- Feeling sluggish, hazy, foggy, or groggy
- Difficulty paying attention
- Memory problems
- Confusion
What should I do if I think I have a concussion?
• Tell your coaches and your parents. Never ignore a bump or blow to the head even if you feel fine. Also, tell your coach right away if you think you have a concussion or if one of your teammates might have a concussion.
• Get a medical check-up. A doctor or other health care professional can tell if you have a concussion and when it is OK to return to play.
• Give yourself time to get better. If you have a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have another concussion. Repeat concussions can increase the time it takes for you to recover and may cause more damage to your brain. It is important to rest and not return to play until you get the OK from your health care professional that you are symptom-free.
How can I prevent a concussion?
Every sport is different, but there are steps you can take to protect yourself.
- Use the proper sports equipment, including personal protective equipment. In order for equipment to protect you, it must be:
- The right equipment for the game, position, or activity
- Worn correctly and the correct size and fit
- Used every time you play or practice
- Follow your coach’s rules for safety and the rules of the sport.
- Practice good sportsmanship at all times.
If you think you have a concussion: Don’t hide it. Report it. Take time to recover.
It’s better to miss one game than the whole season.
For more information and to order additional materials free-of-charge, visit: www.cdc.gov/Concussion.
HEADS UP CONCUSSIONIN HIGH SCHOOL SPORTS A FACT SHEET FOR ATHLETES U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION
Know Your Concussion ABC's
What is a concussion?
A concussion is a type of brain injury that changes the way the brain normally works. A concussion is caused by a bump, blow, or jolt to the head. Concussions can also occur from a blow to the body that causes the head and brain to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious.
Concussions can have a more serious effect on a young, developing brain and need to be addressed correctly.
What are the signs and symptoms of a concussion?
You can’t see a concussion. Signs and symptoms of concussion can show up right after an injury or may not appear or be noticed until hours or days after the injury. It is important to watch for changes in how your child or teen is acting or feeling, if symptoms are getting worse, or if s/he just “doesn’t feel right.” Most concussions occur without loss of consciousness.
If your child or teen reports one or more of the symptoms of concussion listed below, or if you notice the symptoms yourself, seek medical attention right away. Children and teens are among those at greatest risk for concussion.
| Signs Observed by Parents or Guardians | Symptoms Reported by your Child or Teen Thinking/Remembering: | Symptoms Reported by your Child or Teen Emotional: |
|---|---|---|
|
Physical:
|
Sleep:
|
To download this fact sheet in Spanish, please visit: www.cdc.gov/Concussion.
DANGER SIGNS
Be alert for symptoms that worsen over time. Your child or teen should be seen in an emergency department right away if s/he has:
- One pupil (the black part in the middle of the eye) larger than the other
- Drowsiness or cannot be awakened
- A headache that gets worse and does not go away
- Weakness, numbness, or decreased coordination
- Repeated vomiting or nausea
- Slurred speech
- Convulsions or seizures
- Difficulty recognizing people or places
- Increasing confusion, restlessness, or agitation
- Unusual behavior
- Loss of consciousness (even a brief loss of consciousness should be taken seriously)
Children and teens with a concussion should NEVER return to sports or recreation activities on the same day the injury occurred. They should delay returning to their activities until a health care professional experienced in evaluating for concussion says they are symptom-free and it’s OK to return to play. This means, until permitted, not returning to:
- Physical Education (PE) class,
- Sports practices or games, or
- Physical activity at recess.
What should I do if my child or teen has a concussion?
- Seek medical attention right away. A health care professional experienced in evaluating for concussion can determine how serious the concussion is and when it is safe for your child or teen to return to normal activities, including physical activity and school (concentration and learning activities).
- Help them take time to get better. If your child or teen has a concussion, her or his brain needs time to heal. Your child or teen may need to limit activities while s/he is recovering from a concussion. Exercising or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games may cause concussion symptoms (such as headache or tiredness) to reappear or get worse. After a concussion, physical and cognitive activities—such as concentration and learning—should be carefully managed and monitored by a health care professional.
- Together with your child or teen, learn more about concussions. Talk about the potential long-term effects of concussion and the dangers of returning too soon to normal activities (especially physical activity and learning/concentration). For more information about concussion and free resources, visit: www.cdc.gov/Concussion.
How can I help my child return to school safely after a concussion?
Help your child or teen get needed support when returning to school after a concussion. Talk with your child’s teachers, school nurse, coach, speechlanguage pathologist, or counselor about your child’s concussion and symptoms. Your child may feel frustrated, sad, and even angry because s/he cannot return to recreation and sports right away, or cannot keep up with schoolwork. Your child may also feel isolated from peers and social networks. Talk often with your child about these issues and offer your support and encouragement. As your child’s symptoms decrease, the extra help or support can be removed gradually. Children and teens who return to school after a concussion may need to:
- Take rest breaks as needed,
- Spend fewer hours at school,
- Be given more time to take tests or complete assignments,
- Receive help with schoolwork, and/or
- Reduce time spent reading, writing, or on the computer.
To learn more about concussion and to order materials FREE-OF-CHARGE, go to: www.cdc.gov/Concussion or call 1.800.CDC.INFO.
