CUPYFL CONCUSSION REPORT
This form is to be used to report all injuries from either a game or practice.
Date of concussion?
What Area is the player from?
What Division is this player in
Did the concussion occur during practice or a game?
Have the parents been notified?
Medical Release to Return to Football Activities
I understand that a player must receive Medical Clearance before he or she can return to any football activities.
The Medical Clearance Return to Play Form can be found on the League's website at
under the concussion awareness section. The League's must have a copy of the Medical Release prior to returning.
I understand the Medical Clearance to Play Requirement.
Person Filing this Report
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