PYSC Referee Application
Please fill in all information. Please direct questions to
Full Name *
Date of Birth *
Age as of June 1st *
Address *
Phone Number *
This phone number is *
Email Address (All communication will be via e-mail. Please provide one that is checked frequently!) *
I am a returning referee. *
Years of Experience if Returning Referee
Have you ever been found guilty by a court or other tribunal to have committed a violent act against another person, engaged in any misconduct involving a juvenile OR been convicted of a crime except for a minor traffic violation? *
SAY or PYSC, in their discretion, may use the above information to conduct a criminal background check regardless of the responses above. As an applicant for a Soccer Association for Youth (SAY), Pulaski Youth Soccer Club (PYSC) Referee position, I hereby attest to the truthfulness of the representations I have made, including the information provided in response to the questions regarding my criminal history. I authorize SAY or PYSC to verify the above information and waive any right to confidentiality with respect to the information requested. If requested by SAY or PYSC, I will submit my fingerprints for that purpose. *
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