SAMPLE FORMS & CLEARANCES

CMP PRINTABLE FORMS

 

Sideline Concussion Assessment Test 2

 

Information Package For Parent/Guardian After An Injury

 

Parent/Guardian Declaration Form Giving Permission to Participate

 

Medical Clearance to Resume Physical Training from the treating physician:

 

Parental Clearance to Resume Physical Training

 

Written confirmation from the student-athlete that he/she is symptom free;

 

School Clearance to Resume Physical Training from the School CMP Leader

 

School Clearance to Resume Athletic Competition from the School CMP Leader

 
SAMPLE REPORTS
 

Sample Confirmation Report from CMP that the most recent post-injury ImPACT test score has returned to baseline 

 

Sample Report That ImPACT Test Shows Deficiencies in Brain Function