NCHSAA requires every concussed student-athlete to complete its Return to Play protocol in its entirety before resuming full participation. Form D tracks the five stages, from symptom-limited activity through full practice, with dates, comments and who monitored each, and ends with the examining provider's attestation and the parent's consent to full participation.
The person who monitored the protocol signs after stage 5. The examining licensed physician, athletic trainer, PA, NP, neuropsychologist or physical therapist signs the Return to Play attestation, and a parent or legal guardian signs consent.
Download the current version from the source each time; forms change without notice.
NCHSAA Concussion Return to Play (RTP) Protocol Form
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A licensed physician, athletic trainer, physician assistant, nurse practitioner or neuropsychologist. A first responder may monitor under the direction of a licensed provider when one is not directly available, and must confirm review with that provider before stage 4.
That the athlete reports being completely free of clinical signs and symptoms at rest and with full cognitive and physical exertion, and has completed the required protocol through stage 5. Signing gives consent to resume full participation without restriction.
Yes. NCHSAA posts the Concussion Return to Play Protocol Form, revised June 2026, in English and Spanish on its concussion awareness page with the other Gfeller-Waller forms, including Form C and the Return-To-Learn Recommendations.