Referee Availability Form

First Name: MI: Last Name:	Your Age: 12 13 14 15 16 17 18–21 22-35 35–50 51–65 65+
Address:	City: State: OH Zip:
Primary Contact Phone Number: ()	Secondary Contact Phone Number: ()
Primary Email Address:	Secondary Email Address:
I am a first year referee: Yes No	USSF Referee Grade: 5 6 7 8 9 12 Number of years in current USSF Referee Grade:
My children and/or I play and/or coach the following team(s): Team 1: Team 2: Team 3: Team 4:
I request that I be considered for assignment of the following referee ratings:
Maximum Center Rating: none 10 11 12 13 14 15 16 17 18 19	Maximum Assistant Referee (Linesperson) Rating: 10 11 12 13 14 15 16 17 18 19
Note: Youth referees are generally assigned a rating 3 years under their age for centers and 2 years for A.R.’s.
I agree to the following terms and conditions: Only currently licensed, USSF referees who return this form will be shown in the MOSSL online referee assigning system. By submitting this form, all referees acknowledge that they are independent contractors for their work as referees in MOSSL league and tournament games and that the MOSSL assignor(s) have the sole right to include or to not include referees in the MOSSL online referee assigning system. Furthermore, as with any other USSF Assignor, the MOSSL assignor retains the right to determine the level of assignment by which a referee may be listed in the MOSSL online referee assigning system. All referees officiating MOSSL games must have basic verbal and written skills in the English language as those skills would relate to their work as a soccer referee during youth soccer games in MOSSL. All ADULT referees must have an OSYSA Risk Management form on file with Ohio South, (within the last year), before you will be allowed to officiate M.O.S.S.L. games. All referees should avoid signing up for games involving teams and/or clubs with which they have a direct association. To do so, may be a violation of the referee Code of Ethics. However, helping to officiate a game when one of the assigned referees fails to appear for a game or is unable to complete a game may be done if both coaches are made aware of the referee’s direct association with the team(s) and if both coaches give their approval. Only currently licensed, USSF referees who return this form will be shown in the MOSSL online referee assigning system. By submitting this form, all referees acknowledge that they are independent contractors for their work as referees in MOSSL league and tournament games and that the MOSSL assignor(s) have the sole right to include or to not include referees in the MOSSL online referee assigning system. Furthermore, as with any other USSF Assignor, the MOSSL assignor retains the right to determine the level of assignment by which a referee may be listed in the MOSSL online referee assigning system. All referees officiating MOSSL games must have basic verbal and written skills in the English language as those skills would relate to their work as a soccer referee during youth soccer games in MOSSL. All referees should avoid signing up for games involving teams and/or clubs with which they have a direct association. To do so, may be a violation of the referee Code of Ethics. However, helping to officiate a game when one of the assigned referees fails to appear for a game or is unable to complete a game may be done if both coaches are made aware of the referee’s direct association with the team(s) and if both coaches give their approval. I understand that if I fail to remain in compliance with the above terms and conditions, I will be removed from the MOSSL online referee assigning form until such time as I am in compliance with the above listed terms and conditions. OSSRC Referee Re-Certification Program: http://www.ossrc.com/   All adult referees, (age 18 and older), must complete and OSYSA Risk Management form on or after July 1st of each year.  The form can be found at: http://www.osysa.com/about/risk.htm When you complete the online form, make sure that the first designation is that of a District 3 Referee: Member League Code: List all leagues and/or referee districts for which you will be working and/or volunteering with during the coming year. You must enter at least one.  1. DISTRICT 3 REFEREES   After the form is completed, make sure that you print multiple copies of the printed forms that says, “SUBMITTED”.      For more information regarding officiating MOSSL games, please contact: MOSSLSOC@AOL.COM or Tom Conger, MOSSL’s Referee Assignor, at tconger1@insight.rr.com.