Staffordshire County Senior 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
    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
    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
    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
    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
    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
    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
    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
    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
    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

    Tuesday Dates
    Wednesday Dates


    Please state your closed dates for the next month:

    Saturday Dates
    Monday Dates

    Tuesday Dates
    Wednesday Dates

    Do you want a copy of this completed form to be sent to your email address?