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Return To Sports Instructions


Your child may need to give his school or coach a return to sports form after an illness, injury, or procedure. Ask your child's healthcare provider to fill out this release. Make copies of the form. Keep one copy and give another copy of the completed form to your child's school or coach.


Date of illness, injury, or procedure:

Do not return to sports until your child's healthcare provider says it is okay.
  • May return to sports with the following restrictions:
  • May return to sports with NO restrictions on:
  • Follow-up visit information:

Healthcare provider's signature:

Date signed:

Date of last medical evaluation (if different than above):

Medical healthcare provider's name and information (please print):

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.