WHAT YOU NEED TO KNOW:

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:

• 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):

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.