1. Southeast Region Pop Warner Team Book Order Updated 2013

2. 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

3. . Book Certification Error Form This form documents items that are incorrect.

4. 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: 2 nd page of Physical form – Doctor’s Signature page Sleeve #2 BACK: 1 st page of Physical form Sleeve #3 FRONT: 2 nd page of Participant/Parental Consent Form – Signature page Sleeve #3 BACK: 1 st 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

5. 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.

6. 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

7. Foreign Language Birth Certificate Sample Translation Form

8. Sleeve #2 Front- Pop Warner Physical Form- 2 nd 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

9. Title Can They Complete and sign off on the Physical ReasonAuthority Medical Doctor (MD)YesAble to diagnoseFla. Stat. 458.305 Doctor of Osteopathy (DO)YesAble to diagnoseFla. Stat. 459.003 Physician AssistantsYes 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 AssistantNoNot able to perform diagnoses458.3485 Advanced Registered Nurse Practitioner (ARNP): including certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners YesGiven 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)YesGiven 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)Nono 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)No Nursing 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 TrainerNo Can 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 assistantNo 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 AssistantNo only assistant with patient care management and administrative and clinical procedures. Not able to diagnose. 460.4166; F.A.C. 64B2-18.001(6) AcupuncturistNo Acupuncturist may not diagnose medical conditions outside of the need for acupuncture. 457.102(1), 457.104 FS; 64B1- 4.011 F.A.C.

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

11. 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

12. 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.

13. 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.

14. Sleeve # 4 Back Waivers/Special information. All Legal paperwork including: Examples: Waivers-(1 st ) Name Changes Guardianship Adoption papers Team Parent, Jr. Coach, Coach Trainee & Student Demonstrator certificates