Grassroots Referee Program - Town/Club Information Request

GENESIS REFEREE PROGRAM

Town/Club Information Request

LEGAL/OFFICIAL NAME OF TOWN/CLUB *

WEBSITE *

PRIMARY CONTACT NAME *

PRIMARY CONTACT EMAIL *

PRIMARY CONTACT PHONE NUMBER *

ADDITIONAL CONTACT NAME *

ADDITIONAL CONTACT NAME

ADDITIONAL CONTACT EMAIL

ADDITIONAL CONTACT PHONE NUMBER

DESIRED SEASON TO IMPLEMENT GRASSROOTS REFEREE PROGRAM *

DO YOU HAVE A CURRENT IN-TOWN REFEREE PROGRAM? *

YES

IF YES, PLEASE ATTACH ANY CURRENT DOCUMENTS AND CURRICULUM USED AND/OR A NARRATIVE/OVERVIEW OF THE PROGRAM

ESTIMATED NUMBER OF IN-TOWN GAMES BY AGE/GRADE GROUP WEEKLY *

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DAYS/TIME FRAME OF PLAY *

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GENERAL FIELD CONFIGURATION BY AGE GROUP (I.E., ONE SITE- MULTIPLE FIELDS, ONE SITE PER GRADE GROUP) ETC. *

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LOCAL RULES OF COMPETITION WHETHER GENERAL (ACROSS ALL GRADE GROUPS) OR GRADE SPECIFIC IF NOT INCLUDED IN DOCUMENTS PROVIDED (EXAMPLE: GRADE 1 4V4 NO GOALIE, KICK INS, NO PK, SUBS ON ANY STOPPAGE, RETREAT TO MIDFIELD ON GOAL KICKS, 2 X 24 MINUTE HALVES WITH BREAKS AT 8 MINUTES) *

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ANY ADMINISTRATIVE PROCESSES TRAINERS WILL NEED TO KNOW- CONTACTS, SUBMITTING AVAILABILITY, GETTING ASSIGNED AS WELL AS INSTRUCTION ON GAME REPORTING, DEALING WITH COACHES/PARENTS, INCIDENTS. *

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WHAT ARE THE UNIFORM/EQUIPMENT REQUIREMENTS AND WHO IS RESPONSIBLE FOR PROVIDING THEM? (JERSEY, WRISTWATCH, WHISTLE, WRIST LANYARD OR FINGER-GRIP ARE MINIMUMS) *

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DO YOU HAVE A FACILITATOR IN PLACE OR ANY TO BE TRAINED AND ACCREDITED? *

YES

DO YOU HAVE ON-FIELD MENTORS AVAILABLE TO BE TRAINED? *

YES

ANY ADDITIONAL SPECIAL CONSIDERATIONS OR INFORMATION YOU WISH TO PROVIDE *

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