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Staffordshire County Senior League - FA Charter Standard League

Referee acknowledgement form

This form is to be completed upon receipt of your monthly fixtures and then submitted (Submit button at bottom of form).

Failure to do so may mean the loss of appointments.

This completed form is still required to be submitted even if you do not have any fixtures for the present month as it informs the secretary of your closed dates, if any.

Referee acknowledgement form

Referees name (required)
Date of form completion (required)


I acknowledge the following fixtures for all of my games this month:

Game 1 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you are the Referee
Referee
Tick if you are the Assistant
Assistant


Game 2 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you are the Referee
Referee
Tick if you are the Assistant
Assistant


Game 3 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you are the Referee
Referee
Tick if you are the Assistant
Assistant


Game 4 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you are the Referee
Referee
Tick if you are the Assistant
Assistant


Game 5 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you are the Referee
Referee
Tick if you are the Assistant
Assistant


Game 6 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you are the Referee
Referee
Tick if you are the Assistant
Assistant


Are you unavailable for any of the games you have been appointed?

YesNo

Which games are you unable to officiate?

Game 1 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you were to be the Referee
Referee
Tick if you were to be the Assistant
Assistant


Game 2 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you were to be the Referee
Referee
Tick if you were to be the Assistant
Assistant


Game 3 details:

State what league or cup comp.
Date of game

Home team
Away team

Tick if you were to be the Referee
Referee
Tick if you were to be the Assistant
Assistant


Are you Available for any further appointments this month:

Saturday Dates
Monday Dates
Wednesday Dates


Please state your closed dates for the next month:

Saturday Dates
Monday Dates
Wednesday Dates