Los Padres Soccer Referee Association - SCSOA Unit F Membership Application Form

Full Name*

First NameM.I.Last Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home E-mail*

Other E-mail

Cell Phone*

Area CodePhone Number

Other Phone

Area CodePhone Number

Primary Language

Other Language

High School Experience*

YesNo

# of Years Experience*

USSF Registered*

YesNo

USSF Grade*

# of Years USSF*

Have you ever been convicted of a felony, a crime of violence, any crime against an individual, or fraud?*

YesNo

(If "Yes," please meet with C.I.F. coordinator)

I will be leaving from this City/ZIP Code to do games*

I am a High School Coach, or have conflicts with a school or team*

YesNo

School*

Team*

Do you have any Children/Family Members attending High School?*

YesNo

School Attending*

Are the playing soccer*

YesNo

What team?*

	Varsity	Junior Varsity
Boys
Girls

By signing this application, I am agreeing that I am an independent contractor and voluntary seek to officiate games assigned by the unit. I agree to hold SCSOA Unit F, its officers and assignors harmless for anything that occurs to me or my property while performing any task related to refereeing soccer matches assigned under the direction of SCSOA Unit F. I agree to accept tournament fees that are lower than Blue Book fees as negotiated by the board. I also understand that continued membership and assignments are conditioned upon my compliance with the ethical and professional standards of the SCSOA and SCSOA Unit F bylaws. I also understand that I may be dropped from assignments and have my membership terminated by my failure to follow these ethical standards. I attest that I am legally able to work in the United States. I further understand that I am not guaranteed any assignments.

Signature*

Name

First NameLast Name

Date