REFEREE APPLICATION
 
Biographical Information
 
First Name           Last Name  
 
Address    City      
State                                    Zip Code                       

Email  
 
Home Telephone (ex. 502-555-5555)           
Work Telephone (ex. 502-555-5555)        
Cellular Telephone (ex. 502-555-5555)          
 
Date of Birth (ex. 01/25/82)          
 
 
   
License Information
 
Are you currently registered for 2011?  
Yes No
Referee Grade
(Most Referees begin at a Grade 9 or 8)
9 8 7 6
or
16		 5
or
15		 4
or
14		 3
or
13
Referee Patch is Blue
Patch says "Referee"
Patch says
"State Referee"
Patch says
"National Referee"
Patch says "Professional Referee"
 
Years of Licensed Referee Experience
 
 
 
 
Availability
(PLEASE CHECK ALL THAT APPLY)
Games will be assigned based on the following factors: Referee Grade, Fitness Level, Years of Experience, and On-Field Performance. We want accurate, safe, decisions, and the kids to have FUN.
Most referees will be assigned approximately 2-4 games per day.
SAT
8AM
10AM
12PM
2PM
4PM
6PM
SUN 
8AM
10AM
12PM
2PM
4PM
6PM
 
 
Conflicts
(If you don't have any conflicts, please SKIP this section.)
(In this section you can identify the teams or clubs that you don't want to be scheduled to referee.  For example, if you play, coach, or have a relative on a team, please list the Team Name, Age Group, and Gender.  If you have an affiliation with a club and not a specific team, please list them under the Club Conflict section.  I will make every effort possible NOT to schedule you into these games/time slots.)
 
Team Conflict #1
Team Name     Club Name
Age Group (ex. U-16)   Gender (ex. M or F)
 
Team Conflict #2
Team Name     Club Name
Age Group (ex. U-16)   Gender (ex. M or F)
 
Team Conflict #3
Team Name     Club Name
Age Group (ex. U-16)   Gender (ex. M or F)
 
Club Conflict #1   or   NOTES TO THE ASSIGNOR
(ex. Assistant Referee only OR want to work with... OR will be riding with... OR wanting an assessment)
--------------- ---------------
 
Club Conflict #2    or   MORE NOTES TO THE ASSIGNOR
--------------- ---------------
 
 
- HOTELS ARE NOT AVAILABLE FOR THE FALL TOURNAMENT -