| Surname
Forename
Gender Male/Female |
| Address
|
| |
|
Post Code
|
| Home Telephone Number
Mobile Number
|
| E-Mail Address
|
| Date of Birth
Year of qualification as a referee
|
| To which F.A.are you affiliated
Registration Number
|
| To which R.A.are you affiliated
|
| Level
Number of active seasons at this level
|
| Date child protection training completed over18's only, |
| Date CRB check completed,
|
| Mini - Soccer Referees |
| Mini-Soccer Centre at which you referee,
|
| When you are not required to officiate at a Mini-Soccer
Centre, could you |
| Referee at an alternative mini soccer centre --
Yes
----- No
|
| Referee an 11-a-side game ----- -------------Yes
----- No
|
| 11-a-side Referees |
| Please state age group preference (if any) for p.m. games
|
| Availability please indicate yes or no (Week 1 is first Sunday in
the month) |
| ___________ 10.30 AM _______________2.15 PM |
| Week 1
Week 1
|
| Week 2
Week 2
|
| Week 3
Week 3
|
| Week 4
Week 4
|
| Do you have transport to get to matches? yes/no
|
| If you are connected to any club in the Walsall Junior Youth league |
| please state which club |
| Details of all fixtures will be sent by post, and will be on the website:
www.wjyl.co.uk |
| Contact details will also be on the WJYFL website, This should enable
clubs to get in touch with you without delay |
| However, if you do not wish your details to be published please put
an x in the box
|
| Signed:
------------- ---------
|
| Please return to, Julie Anstey, 10 Coppice Close,Cheslyn Hay,Walsall,WS6
7EZ |
| Or e-mail to : anstey@btinternet.com |