PYSC Referee Application

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Please fill in all information. Please direct questions to referee@pulaskiyouthsoccer.com

Email *

Full Name *

Date of Birth *

YYYY

Age as of June 1st *

Full Address *

Phone Number *

This phone number is *

My cell phone

Other:

Email Address (Most communication will be via e-mail. Please provide one that is checked frequently! Do not use a school email address if you cannot check it over the summer) *

I am a returning referee. *

Yes

Years of Experience if Returning Referee

Have you ever been found guilty by a court or other tribunal to have committed a violent act against another person, engaged in any misconduct involving a juvenile OR been convicted of a crime except for a minor traffic violation? *

Yes

SAY or PYSC, in their discretion, may use the above information to conduct a criminal background check regardless of the responses above. As an applicant for a Soccer Association for Youth (SAY), Pulaski Youth Soccer Club (PYSC) Referee position, I hereby attest to the truthfulness of the representations I have made, including the information provided in response to the questions regarding my criminal history. I authorize SAY or PYSC to verify the above information and waive any right to confidentiality with respect to the information requested. If requested by SAY or PYSC, I will submit my fingerprints for that purpose. *

A copy of your responses will be emailed to the address you provided.

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