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Next Level Referee School Application

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Full Name_______________________________________________      DOB____________
 
 
Address ____________________________________________________________________
                    (Street, City, State, Zip
 
Home phone__________________________     Cell phone___________________________
 
 
Email Address_______________________________________________________________
 
 
Highest level of officiating___________________________     Years at this level___________
 
 
Name of supervisor____________________________________________________________
 
 
Supervisor phone number or email address_________________________________________

I understand that Next Level Referee School, Villanova University, and all personnel associated with the camp/school are in no way responsible should I become injured while in attendance or while officiating games.   My signature indicates that I agree not to hold any individual or group responsible should an injury occur.
 
Signature___________________________________________     Date____________________
 
School space is limited and applications will be processed on a first come, first served basis.   You will be notified by email of your status as forms and payments are received.   More detailed school information and a more in-depth official form will be sent out in a few weeks.   Thank you in advance for your interest!

 

Please include check for $250 made payable to Next Level Referee School.
Send form and payment to:
Next Level Referee School
20 Grace Court
Swedesboro, NJ 08085.