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 www.ctreferee.net for certification information. Contact nscassignor@gmail.com with question.

*New Referees Only* - If you completed this for Fall 2017, 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 nscassignor@gmail.com with those changes.

Email address *
Referee First Name *
Your answer
Referee Last Name *
Your answer
Referee Date of Birth *
MM
/
DD
/
YYYY
Referee Email *
Your answer
Referee Phone Number *
Your answer
Please list any potential conflicts of interest (i.e. your team(s), family member's team(s), your coach's other team(s), etc.)
Your answer
Parent/Guardian 1 Name
Your answer
Parent/Guardian 1 Email
Your answer
Parent/Guardian 1 Phone Number
Your answer
Parent/Guardian 2 Name
Your answer
Parent/Guardian 2 Email
Your answer
Parent/Guardian 2 Phone Number
Your answer
Parent/Guardian 3 Name
Your answer
Parent/Guardian 3 Email
Your answer
Parent/Guardian 3 Phone Number
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms