The COVID-19 pandemic presents state high school associations with a myriad of challenges. The NFHS Sports Medicine Advisory Committee (SMAC) offers this document as guidance on how state associations can consider approaching the many components of “opening up” high school athletics and activities across the United States. The NFHS SMAC believes it is essential to the physical and mental well-being of high school students across the nation to return to physical activity and athletic competition. The NFHS SMAC recognizes that it is likely that ALL students will not be able to return to – and sustain – athletic activity at the same time in all schools, regions and states. There will also likely be variation in what sports and activities are allowed to be played and held. While we would typically have reservations regarding such inequities, the NFHS SMAC endorses the idea of returning students to school-based athletics and activities in any and all situations where it can be done safely. Since NFHS member state associations are a well-respected voice for health and safety issues, the NFHS SMAC strongly urges that these organizations engage with state and local health departments to develop policy regarding coordinated approaches for return to activity for high school, club and youth sports. The recommendations presented in this document are intended as ideas for state associations to consider with their respective SMACs and other stakeholders in designing return-to-activity guidelines that will be in accordance with state or local restrictions. Please note that the phases of “opening up” outlined below are based upon the White House document released in April 2020. Consult your state and local health departments to review if they are using a similar approach, or how the phases in this document correspond to your state or local governments nomenclature.