Submit the completed form to your local Pop Warner organization either in person or via mail. Email and fax submissions may be accepted if verified with your local organization. Always ensure that both Section I and Section II are fully completed and signed before submission to avoid delays. Contact your local organization for specific submission details and advice on the preferred method of submission. Keep a copy of the completed form for your records.

For 2024 and 2025, the form must be dated after January 1st of the respective year and submitted to your local Pop Warner organization.

The purpose of the 2015 Pop Warner Physical Fitness & Medical History Form is to ensure that all participants in Pop Warner activities are physically fit and safe to engage in sports. This medical history form provides important information about a child's health, including any injuries, surgeries, medications, and other medical conditions. By collecting this information, Pop Warner can ensure that all participants are monitored and cared for appropriately. Another key purpose of thi...

• 1. Participant's Legal Name: The full legal name of the participant as shown on their birth certificate.
• 2. Address: The participant's current residential address, including city, state, and zip code.
• 3. Date of Birth: The participant's birth date in MM/DD/YYYY format.
• 4. Telephone No: A contact number where the participant or parent/guardian can be reached.
• 5. Medical Insurance Information: Details of the participant's primary medical insurance including the insurance company name, policy number, membership number, and the name of the primary insured.
• 6. Medical History Questions: A series of questions regarding the participant's medical history such as injuries, surgeries, concussions, medications, allergies, asthma, diabetes, sickle cell, seizures, vision, brace or support devices, and any other physical limitations or medical conditions.
• 7. Parent/Guardian Certification: A certification statement for the parent/guardian to sign, confirming the accuracy of the information provided and acknowledging their responsibility to inform the organization of any changes in the participant's medical condition.
• 8. Medical Professional Certification: Section II includes fields for the medical professional to certify the participant's fitness, including their professional designation, licensure status, and contact information.

Failure to submit the completed form may result in the participant being ineligible to join Pop Warner activities. The form is crucial to ensuring the safety and fitness of all participants.

• Ineligibility for Participation: Without submitting the form, the participant will not be allowed to join any Pop Warner activities.
• Lack of Medical Clearance: The organization's officials and coaches will not have the necessary medical information to ensure the participant's safety.
• Potential Health Risks: Failure to provide accurate medical history increases the risk of health problems during participation.

• 1. Pop Warner Football Registration: Submit the form to register a child for Pop Warner football.
• 2. Pop Warner Cheer Registration: Submit the form to register a child for Pop Warner cheer.
• 3. Pop Warner Dance Registration: Submit the form to register a child for Pop Warner dance.
• 4. Annual Medical Clearance: Use the form annually to ensure continuous medical clearance for ongoing participation.
• 5. Post-Injury Resumption: Submit an updated form after any injury, illness, or accident to resume participation.