Massachusetts Department of Health Concussion Information
WRSD Concussion Policy
WRSD Concussion Protocol
Head Injury Guide
Pre-Participation Head Injury/Concussion Reporting Form
for Extracurricular Athletic Activities
This form should be completed by the student’s parent(s) or legal guardian(s). Please submit this form to the
Athletic Director, or official designated by the school, prior to the start of each season a student plans to
participate in an extracurricular athletic activity.
Report of Head Injury During Sports Season Form
For Coaches: Please complete this form immediately after the game or practice for head injuries that result in
the student being removed from play due to a possible concussion.
For
Parents/Guardians: Please complete this form if your child has a head injury outside of school related
extracurricular athletic activities.
Post Sports-Related Head Injury Medical Clearance and Authorization Form
For parents and students: Please have your medical care provider complete this form and return it to your Athletic Director,
Athletic Trainer, or School Nurse.