Officials & Coaches Contact Form
All Referee's, Umpires & Coaches are required to fill in this form
Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Contact Email
example@example.com
Any relevant Medical Conditions?
Current Qualifications / Badge Level / Experience
Emergency Contact Or Parent / Guardian for those Under 18 Yrs (Please provide Name & Contact Number)
General Availability
Monday Juniors (4-6pm)
Tuesday Juniors (4-6pm)
Wednesday Juniors (4-6pm)
Thursday Juniors (4-6pm)
Monday Seniors (6-11pm)
Tuesday Seniors (6-11pm)
Wednesday Seniors (6-11pm)
Thursday Seniors (6-11pm)
Sunday Seniors (2-8pm)
Specific Availability / Notes
Eg. Do you play for any teams - Provide Team Name & Day OR Mon available only till 9pm OR Tuesday available only first 3 Games, Sunday Available All Time slots ect ect.
DCSI Paperwork (attach photo or scanned document of DCSI)
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of
Statement by a Supplier (Attach completed Statement by a Supplier Form)
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Terms & Conditions
By Submitting this form you are acknowleging and agreeing to the below T&C's. By refereeing and/or supervising within a Mars Sports Centreprogramme you agree to officiate in line with the centres participation guideand FIBA rulings.You acknowledge that as a referee and/or supervisor that youhave a Duty of Care to the players to ensure that they participate in a safeand fair environment.In line with the Statement of Supply, you acknowledge thatyou are officiating in the course or furtherance of an activity done as aprivate recreational pursuit or hobby.Additionally, by signing this form you understand that allliabilities, specific to injury insurance are waived and medical expenses willbe at the signatures own out of pocket expenses.
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