Referee Certification Classes Spring 2026
This form must be filled out by all new and returning referees before their admittance to classes. All necessary documentation must be brought to the class with the referee for board approval.

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Name *
Email address *
Phone number *
Are you 12 years of age or older? *
Age *
Birthdate *
MM
/
DD
/
YYYY
Emergency Contact Info (Name, Phone Number) *
Do you currently play in NWISL? *
If yes, what age group, club and team name? (I.e. U14B Valpo Warriors)
Do you have any of the following medical conditions *
Required
Do you take any medications on a daily basis; or have any health conditions that need further explanation? Please list here.
Do you have any allergies (food, medication, animal)?
 *
Do you have a USSF / IHSSA license? *
Required
Which date are you signing up for? *
Which training program(s) are you signing up for? *
Required
Which locations would you prefer to work? *
Are there any clubs you are not willing to ref? *
How far are you willing to travel? *
What age groups do you feel comfortable working? (Note: Center referees must be 2 years older than the game you are officiating.) *
Required
For Minor Referees (Under Age 18):

A parent or guardian must fill out a copy of the attached work release form and e - sign the document with a first and last name (complete signature) before any games will be assigned to the minor referee.

A hard copy of the form may also be printed, signed, and emailed to the following email address:

nwislsecretary@gmail.com

Please also E - Sign Below when the forms have been completed.

E - Copy Link:

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