Referee Course Expression of Interest Form

If you are interested in becoming a Referee, then please click on the Next button shown below and complete your application. Once completed, our Referee Development Manager (RDM) will then provide you with further information. Please bear in mind there is a waiting list! In order to successfully book onto a course, you will be required to complete The FA Laws of the Game Modules via http://bit.ly/Online-Ref. This can be accessed immediately. For guidance and support, please visit: https://www.hampshirefa.com/referees/development-and-courses Kind Regards Referees Department Hampshire Football Association

Personal Details

Please complete the personal details of the learner below.

FAN*

(This is the FAN of the individual wish to take the course, not the parent or guardian)

First Name*

Last Name*

Gender*

Date of Birth*

Learners must be aged 14 or over at the time of the course.

Home Address*

Please ensure you complete this correctly, House No/Street Name, City/Town and County

Postal Code*

Contact Number*

If you are under the age of 18, please ensure the contact number is that of a parent/guardian.

Learners Email Address*

If learner is under 18, this must be different to the Parent/Carers email address and will be used solely for access to online profiles and systems.

Parent/Carer Email

Please ensure this is the email address of parent/carer if Learner is aged under 18. This will be used for correspondence.

Photo Consent

I give permission for Hampshire FA to take photography/filming during the course.

Family/Care Legal Proceedings

I confirm that my child is not currently involved with family/care legal proceedings.

Course Options

Course Location*

Please select where you would prefer to do you course (multiple select)

Select

Please outline below why you wish to become a referee?*

How did you find out about becoming a Referee?

If none of the below, please enter manually.

Select or enter value

Your Football

If you are 16 years of age and under and still play football, you will need be flexible in your games as both a player and a match official we will do our utmost so that you can still do both, and you will be supported by your local referee appointment secretary.

Do you currently play football?*

Select All of the Days you play on.

Select

Which format would you like to referee?*

Select

Do you intend to continue playing whilst officiating?*

Select or enter value

Medical Info

Please list any allergies etc

Send me a copy of my responses

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