Massachusetts Concussion Management Coalition
School Expectations Form
2016 - 2017 Academic Year
All schools under the Massachusetts Concussion Management Coalition (MCMC) umbrella are at the
forefront of the movement for consistent treatment of mild traumatic brain injuries, more commonly
known as concussions. However, this comes with certain obligations that will not only make your
school’s program the best it can be, but also assures that your school is setting a good example for those
that may want to join in later years. Outlined below are the expectations that MCMC schools are
required to agree to in order to become part of the program.
Please read over the following expectations carefully. The signature of the principal or the athletic
director is required for participation in MCMC.
1. I agree that baseline tests and post-concussion tests in my school will be administered properly,
according to ImPACT guidelines. (Available at: https://www.impacttest.com/)
2. I agree to utilize best practices with respect to return-to-play guidelines set forth by the Zurich
Report. (Available at: http://bjsm.bmj.com/content/47/5/250.full )
3. I support MCMC’s goals of raising awareness for concussion management to reduce concussions,
post-concussion syndrome, and second impact syndrome through education and unified best
practices.
4. I agree that MCMC can hold an educational session, as deemed necessary, with my coaches,
parents, and athletes to teach them:
a. How to recognize a concussion
b. The biology of concussions and the purpose of neurocognitive testing
c. The short and long term consequences of concussions
d. Proper return-to-play guidelines
5. I understand that our school may utilize and distribute The MCMC Information Sheet to the
parent/guardian of the student-athletes.
By signing this form, I agree to all of the above conditions and expectations.
Name (Please Print)
School
Signature (Principal/Athletic Director)
Email
Date
Disclaimer: The Massachusetts Concussion Management Coalition (MCMC) supports the use of cognitive testing (also known as
neuropsychological testing or NP testing) and seeks to promote a shared commitment to best practices regarding concussion treatment and
return to play (RTP) guidelines. MCMC information, testing, and guidelines are not intended as a standard of care and should not be interpreted
as such. Information from MCMC is only a guide and is of a general nature consistent with the reasonable practice of a healthcare professional.
Individual treatment will depend on the facts and circumstances specific to each individual case and remain the sole responsibility of the health
care provider(s).
MCMC supports the perspective on RTP decisions and patient care responsibility set forth in what is commonly referred to as the Zurich Report,
November 2012, which is available in its entirety on our website.