Form dummy page – Become a referee

Name *

First

Last

Please put the name of the person undertaking the course here. It will appear on their certificate.

Email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Local area Association / University. *

Please choose your local area association. If you're not sure which one you fall under email [email protected] with your postcode.

Choose your end of course practical session *

Once you've passed your exam you'll be asked to attend a final face to face session, where you'll receive your certificate and finalise your referee admin.

Note: In order to officiate at youth level you'll need to get an up to date CRB check. Please email your course leader David Rees - [email protected] to ask for the form and with any questions. David is also the local area representative so feel free to email him about any local level questions.

Note: In order to officiate at youth level you'll need to get an up to date CRB check. Please email your course leader Sara Hilton - Sara.H[email protected] to ask for the form and with any questions.

Note: In order to officiate at youth level you'll need to get an up to date CRB check. Please email your safeguarding officer, Mr H Davies - [email protected] to ask for the form and with any questions. Richard Burgum is your local area representative so feel free to email him with any questions about local refereeing - [email protected].

Note: In order to officiate at youth level you'll need to get an up to date CRB check. Please email your safeguarding officer, Steve Jones ([email protected]) to ask for the form and with any questions. Steve is also your local area representative so feel free to email him with any questions about local refereeing.

Note: In order to officiate at youth level you'll need to get an up to date CRB check. Please email your safeguarding officer, Paul Williams ([email protected]) to ask for the form and with any questions. Merfyn Edmonds ([email protected]) is your local area representative so feel free to email him with any questions about local refereeing.

Choose your end of course practical session

Once you've passed your exam you'll be asked to attend a final face to face session, where you'll receive your certificate and finalise your referee admin.

Note: In order to officiate at youth level you'll need to get an up to date CRB check. Please email either of your safeguarding officer, Kevin Jones ([email protected]) or Alan Watkins ([email protected] to ask for the form and with any questions. Kevin is also your local area representative so feel free to email him with any questions about local refereeing.

Note: You will be sent notification of the end of course practical session as soon as it is confirmed. It will take place at your University.

Note: In order to officiate at youth level you'll need to get an up to date CRB check. Please email your safeguarding officer, Dylan Griffiths ([email protected])to ask for the form and with any questions. David Horne ([email protected]) and Dylan Griffiths ([email protected]) are your local area representatives so feel free to email them with any questions about local refereeing.

Gender

Age

14-17
18-25
26-30
31-40
41-50
50+

If the user completing the course is below 16 a responsible adult must take responsibility for dropping them off to the final session and picking them up. Alternatively they must organise this with a trusted individual. A responsible adult must stay at the course with the under 16 yr old, unless they sign a disclosure form when dropping off. A responsible adult should check the box below and state their name to show that they understand this protocol.

I understand

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First

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