Referee Application
Name *
Prefix
First *
Last *
Suffix
Social Security Number *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Years lived at current address *
Phone Number *

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Cell Number *

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The following must be completed by ALL volunteers, new or returning.
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 
 No 
Returning Volunteer - Check One: My personal history has/has not changed since last year? *
 Has 
 Has Not 

As an applicant for a SAY posotion, I herby attest to the truthfulness of the representatives I have made, including the information provided in response to the questions regarding my criminal history. I authorize SAY to verify the above information and waive any right to confidentially with respect to the information requested. If requested by SAY, I will submit my fingerprints for that purpose.
Electronic Signature
Date

MM		/
DD		/
YYYY

I would like BCYSA to order my a 10-piece Referee uniform kit that I may purchase upon successful completion of the Referee Training clinic. (Contact BCYSA for current pricing
) *
 Pro Official 
 Pro Official (Woman's) 
 Pro Stripe 
Choose Size *
Email
Email
Email
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