Ridgewood Soccer Association

P.O. Box 117, Ridgewood, New Jersey 07451

Adult Referee Application Form

Print this form, complete it, and mail it to the address above

Adult referees are routinely needed for the RSA traveling programs.  These programs run on Saturday mornings and Sunday afternoons.  All adult referees are paid for their services.  To qualify, each adult referee must be certified by either the NWBSA or USSF-Northern Counties.  Some prior soccer experience is helpful but not necessary to meet this certification.

 

ATTACH PHOTO HERE

(Passport size & style)

Please print your name on the reverse side of the photo

    First Name  ___________________________________

    Last Name  ___________________________________

    Address      ___________________________________

                       ___________________________________

    Day Phone        ________________________________

    Evening Phone   ________________________________

    Email                 ________________________________

 I am currently a Certified Referee:                     NWBSA: _________    USSF: _________

                                                       My Certificate/ID #: ___________________________

I would like to become a Certified Referee:        NWBSA: _______  USSF: ____________

I was a referee in the RSA last year:                    No: ______________ Yes: ___________

                                               If so, in what division:_______________ (Travel or In-town)

 

Signature and Date ___________________________________________________