Southeast Region
Pop Warner
Team Book Order
Updated 2013
Team Book Order
for Book Check
Correct book order:
Start with this documentation
• Certified National Roster
• Book Certification Error Form
• Rostered copies of Mandatory Play Roster
(MPR) from League one
• Head Coaches Certificates (Football and
Cheer/Dance head coaches and at least one
assistant must have ASEP certification &
Southeast Region coaches clinic certification)
• All other Staff Southeast Region Coaches
Certificate
• First Aid/CPR card(copy)
• Emergency Action Plan
• Participants information in the following order:
• Football – O/L-jersey number then regular
weight in jersey number
• Cheer/Dance –
•
•
•
•
Mascots
Coach Trainees
Student Demonstrators
Alpha order for all other participants
.
Book Certification Error Form
This form documents items that are incorrect.
Team Book Order
continued
Certification documentation must be placed in the team
book in the following order for EACH participant:
• Sleeve #1 FRONT:
•
SE Region PW Official ID Card
• Sleeve #1 BACK:
•
Birth certificate (do not attach to ID Card)
• Sleeve #2 FRONT:
• 2nd page of Physical form – Doctor’s Signature page
• Sleeve #2 BACK:
• 1st page of Physical form
• Sleeve #3 FRONT:
• 2nd page of Participant/Parental Consent Form –
Signature page
• Sleeve #3 BACK:
• 1st page of Participant/Parental Consent Form
• Sleeve #4 FRONT:
•
Scholastic info.- GPA Spreadsheet & Report Card
• Sleeve #4 BACK:
•
Waivers, Special information, Team Parent, Jr. Coach,
Coach Trainee and Student Demo certificates go here
also
Sleeve #1 Front -Official ID card
The front of this sleeve must be cut out on the bottom section to allow the
card to be stamped without removing the sheet each week.
The Association fills out the top two sections with the exception of the ‘Certified
Weight & Date’ (for football) and ‘Cheer Certified Insert Date’. The League Official
will be responsible for completing these fields when signing the card to certify the
participant.
The League adds the ‘certified weight & date’ for football, for Cheer/Dance the
League adds the ‘certified date’. The card is then signed by League Official.
League
Stamp in clear area
Sleeve #1 Back - Birth Certificate
(an original certificate or a certified copy)
The League Official should stamp in a clear area on the copy which verifies
they have compared the original certified document to the copy.
If the birth certificate is in a foreign language, a notarized document
translating the vital information into English should be attached. (Sample
translation form on next slide).
Tip: When comparing the birth certificate to the ID card and the roster, make
sure to check the spelling of the child's name and verify the date of birth was
used instead of the date filed as this is a common mistake.
Foreign Language Birth Certificate
Sample Translation Form
All this
area
needs to
be filled
out also
League
Stamp Here
Sleeve #2 Front- Pop Warner Physical Form- 2nd page Doctors
Signature Page
No Whiteout
The League Official should verify the following: the participants name, the physical section is
filled out, the Dr. has signed or stamped the form, the Date of Signature is in the current year,
the medical profession is on the list of approved degrees (see attached list) and if the Dr. has
indicated that follow up is required that there is documentation this has been done. **NOTE:
the following professions are not permitted to perform physicals - RN, Medical Assistants
(MA), LPN, CAN, Athletic Trainers, Certified or Registered Chiropractor Assistants,
Acupuncturists.
Title
Can They
Complete and
Reason
sign off on the
Physical
Authority
Medical Doctor (MD)
Doctor of Osteopathy (DO)
Yes
Yes
Able to diagnose
Able to diagnose
Fla. Stat. 458.305
Fla. Stat. 459.003
Physician Assistants
Yes
Is licensed to perform medical services and
diagnose.
Fla. Stat. 458.347(2)(e); F.A.C.
64B8-30.001 and 64B8-30.012
Medical Assistant
No
Advanced Registered Nurse Practitioner
(ARNP): including certified registered nurse
Yes
anesthetists, certified nurse midwives, and
nurse practitioners
Not able to perform diagnoses
458.3485
Given explicit authority to diagnose.
Fla. Stat. 464.003(3) and (20); Fla.
Stat. 464.012(3); F.A.C. 64B94.001 and 64B9-4.009
Clinical Nurse Specialist (CNS)
Yes
Given explicit authority to diagnose.
Fla. Stat. 464.003(6), (7) and (20);
F.A.C. 64b9-15.002
Registered Nurse (RN)
No
Practices professional nursing, the same as a
CNS and ARNPs. ARNPs are just certified in
advanced or specialized nursing practices.
Can perform assessments and nursing
Fla. Stat. 464.003(20) and (22);
diagnosis. RN's are licensed to do what is
F.A.C. 64B9-15.001
referred to as a nursing diagnosis. Physicals
fall within the scope of what is referred to as a
medical diagnosis, however, and RNs are not
licenses to perform them.
Licensed Practical Nurse (LPN)
No
no authority to perform an diagnosis .
Certified Nursing Assistant (CNA)
No
Athletic Trainer
No
Chiropractic Physician (Chiropractor)
Yes
Certified Chiropractic Physician's assistant No
Registered Chiropractic Assistant
No
Acupuncturist
No
Fla. Stat. 464.003(16) and (19);
464.003(5); F.A.C. 64B9-15.001
Nursing Diagnosis is not listed as a function
Fla. Stat. 464.201(5); F.A.C. 64B9and must perform job under the supervision of
15.002
an RN or LPN
Can treat athletic injuries but no authority to do
Fla. Stat. 468.701 and 468.713;
complete physical examination and make a
64B33-4.001
diagnosis.
Diagnosing medical conditions is not listed
under the definition of the practice of
chiropractic medicine. However, in section (e)
it states that they can analyze and diagnose 460.403(9)(a) and (9)(e).
the physical conditions of the human body to
determine abnormal functions and their
causes.
May perform physical exams but also states
they function in a dependent relationship with a
supervising physician. Also states that they
cannot render diagnostic results or
interpretations or render treatment advice
460.4165; F.A.C. 64B2-18.001(5)
"unless properly certified." My reading is the
Physician must sign off on the physical
because we are asking that they certify there
are no medical impediments to the child
participating in sports activities.
only assistant with patient care management
and administrative and clinical procedures.
460.4166; F.A.C. 64B2-18.001(6)
Not able to diagnose.
Acupuncturist may not diagnose medical
457.102(1), 457.104 FS; 64B1conditions outside of the need for acupuncture. 4.011 F.A.C.
Sleeve #2 Back- Pop Warner Physical Form1st Page
The League Official should verify that the parent or legal
guardian has signed and dated the form as well as fully
completing the medical history information.
League
Stamp Here
Sleeve #3 Front- Participant/Parental Consent
Form- signature page
The League Official is verifying the following on this form:
• The person signing the form is the parent or legal
guardian and the form is dated
• The participants name is on the form
• The participant has signed the form (regardless of how
young)
Sleeve #3 Back- Participant/Parental
Consent Form
This form should be filled out completely above the
'Official Use Only' section, including the email and
emergency contact information.
Sleeve #4 Front- GPA Spreadsheet with full
report card behind the spreadsheet
The names on the GPA Spreadsheet and the report card
must match. The report card must include all 4 – 9 week
periods or semesters from the previous year.
This sheet can ONLY BE STAMPED by the League
Scholastic Coordinator. See above for correct format of
stamp.
Sleeve # 4 Back Waivers/Special information.
All Legal paperwork including:
Examples:
Waivers-(1st)
Name Changes
Guardianship
Adoption papers
Team Parent, Jr. Coach,
Coach Trainee & Student
Demonstrator certificates