Southeast Region Pop Warner

Team Book Order

Updated 2014

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• Football – USA Heads Up Certificate, Southeast

Region Coaches Certificate and Southeast Region Team Parent Certificate.

• Cheer/Dance – YCADA Coaches Certificate, Southeast Region Coaches Certificate and current ASEP

• 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 FormThis 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

• Sleeve #5 FRONT:• Team Parent Certificates

Sleeve #1 Front -Official ID cardThe 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.

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.

League Stamp in clear area

Foreign Language Birth Certificate

Sample Translation Form

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.

All this area

needs to be filled out also

League Stamp Here

Title

Can They Complete and sign off on the Physical

Reason Authority

Medical Doctor (MD) Yes Able to diagnose Fla. Stat. 458.305Doctor of Osteopathy (DO) Yes Able to diagnose 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 Not able to perform diagnoses 458.3485

Advanced Registered Nurse Practitioner (ARNP): including certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners

Yes Given explicit authority to diagnose. Fla. Stat. 464.003(3) and (20); Fla. Stat. 464.012(3); F.A.C. 64B9-4.001 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 diagnosis. RN's are licensed to do what is 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.

Fla. Stat. 464.003(20) and (22); F.A.C. 64B9-15.001

Licensed Practical Nurse (LPN) No no authority to perform an diagnosis . Fla. Stat. 464.003(16) and (19); 464.003(5); F.A.C. 64B9-15.001

Certified Nursing Assistant (CNA) NoNursing Diagnosis is not listed as a function and must perform job under the supervision of an RN or LPN

Fla. Stat. 464.201(5); F.A.C. 64B9-15.002

Athletic Trainer NoCan treat athletic injuries but no authority to do complete physical examination and make a diagnosis.

Fla. Stat. 468.701 and 468.713; 64B33-4.001

Chiropractic Physician (Chiropractor) Yes

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 the physical conditions of the human body to determine abnormal functions and their causes.

460.403(9)(a) and (9)(e).

Certified Chiropractic Physician's assistant No

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 "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.

460.4165; F.A.C. 64B2-18.001(5)

Registered Chiropractic Assistant Noonly assistant with patient care management and administrative and clinical procedures. Not able to diagnose.

460.4166; F.A.C. 64B2-18.001(6)

Acupuncturist No

Acupuncturist may not diagnose medical conditions outside of the need for acupuncture.

457.102(1), 457.104 FS; 64B1-4.011 F.A.C.

Sleeve #2 Back- Pop Warner Physical Form- 1st 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.

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)

League Stamp Here

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 ChangesGuardianship

Adoption papers