Referee Contact information
If you are certified by the Connecticut State Referee Program, proceed to complete the form below. If you are not certified, refer to for certification information. Contact with question.

*New Referees Only* - If you have previously completed this, you do not need to complete it again.

Please complete the fields below. If you are under 18 years old, you must have at least 1 complete parent/guardian contact. This is how you will be contacted for games and assignments, please make sure the information that you enter is accurate. If you have any changes to the information after it is submitted, email with those changes.
Email address *
Referee First Name *
Referee Last Name *
Referee Date of Birth *
Referee Email *
Referee Phone Number *
Please list any potential conflicts of interest (i.e. your team(s), family member's team(s), your coach's other team(s), etc.)
Parent/Guardian 1 Name
Parent/Guardian 1 Email
Parent/Guardian 1 Phone Number
Parent/Guardian 2 Name
Parent/Guardian 2 Email
Parent/Guardian 2 Phone Number
Parent/Guardian 3 Name
Parent/Guardian 3 Email
Parent/Guardian 3 Phone Number
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