Apricot Jam 2026 Referee Information- DOWNLOAD & PRINT THIS FORM AFTER SUBMISSION.
After submission, you will receive a response to your E-mail. IF you do not see it check in your SPAM. After printing your form, get your Regional Referee Administrators approval signature. Return with your Complete Tournament Package (Tournament application, This Referee Information form, Affinity Roster and the Region Check)Mail to:Apricot Jam Tournamentc/o Lisa Viescas12954 View Mesa St.Moorpark, CA 93021. Any changes to the original referee form must be re-submitted ASAP & no later than 14 days before the tournament.
Please confirm your E-mail:
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Referee Requirement
Your team's $350 referee deposit will be refunded if you provide a qualified crew and complete all assignments. A qualified crew consists of three experienced, eligible referees; at least one should be able to serve as center referee in your team’s division. Referees must be registered as volunteers for 2025, certified as AYSO Referee, have GREEN risk management status, and be Safe Haven, Sudden Cardiac Arrest, and CDC Concussion trained. All volunteers need Live Scan fingerprinting and current SafeSport training. Failure to meet these requirements will forfeit your deposit. Coaches with teams in the tournament should not referee. Crews may be split and scheduled separately.
AYSO Region #
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Coach Name
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Who are you representing?
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Boys
Girls
Team Division
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10U
12U
14U
Our team will be providing Referees?
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YES
NO
AYSO Region Name (City)
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Region mailing address:
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Your referee deposit will be sent directly to your Region.
Uniform Color
Name of your Referee Team Contact
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Cell Phone for Referee Team Contact
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Email for Referee Team Contact
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Information for Referee
REFEREE INFORMATION-You must provide complete details for each referee, including a valid email address, to guarantee they receive the self-assignment link.
Referee#1 Legal Name
Referee #1 AYSO ID#
Referee #1 Cell Phone
Referee #1 Email
Referee #1 Badge Level
Regional
Intermidiate
Advanced
National
Youth Referee
Referee #1 Highest level of competency as a CENTER REFEREE
Boys 10U
Girls 10U
Boys 12U
Girls12U
Boys 14U
Girls 14U
Referee #1 Highest level of competency as an ASSISTANT REFEREE
Boys 10U
Girls 10U
Boys 12U
Girls 12U
Boys 14U
Girls 14U
Information for Referee #2
Referee #2 Legal Name
Referee #2 AYSO ID
Referee #2 Cell Phone
Referee #2 Email
Referee #2 Badge Level
Regional
Intermediate
Advanced
National
Youth Referee
Referee #2 Highest level of competency as a CENTER REFEREE
Boys 10U
Girls 10U
Boys 12U
Girls 12U
Boys 14U
Girls 14U
Referee #2 Highest level of competency as an ASSISTANT REFEREE
Boys 10U
Girls 10U
Boys 12U
Girls 12U
Boys 14U
Information for Referee #3
Referee #3 Legal Name
Referee #3 AYSO ID#
Referee #3 Cell Phone
Referee #3 Email
Referee #3 Badge Level
Regional
Intermediate
Advanced
National
Youth Referee
Referee #3 Highest level of competency as a CENTER REFEREE
Boys 10U
Girls 10U
Boys 12U
Girls 12U
Boys 14U
Girls 14U
Referee #3 Highest level of competency as an ASSISTANT REFEREE
Boys 10U
Girls 10U
Boys 12U
Girls 12U
Boys 14U
Girls 14U
Information for Referee #4
Referee #4 Legal Name
Referee #4 AYSO ID#
Referee #4 Cell Phone
Referee #4 Email
Referee #4 Badge Level
Regional
Intermidiate
Advanced
National
Youth Referee
Referee #4 Highest level of competency as a CENTER REFEREE
Boys 10U
Girls 10U
Boys 12U
Girls 12U
Boys 14U
Girls 14U
None
Referee #4 Highest level of competency as an ASSISTANT REFEREE
Boys 10U
Girls 10U
Boys 12U
Girls 12U
Boys 14U
Girls 14U
Regional Referee Administrator Information and Approval
Enter NA if not sending Referees
Name of Region Referee Administer (RRA)
*
Cell Phone for your Region Referee Administer (RRA)
Email for your Region Referee Administer (RRA)
*
Regional Referee Administrator
Your signature ensures this tournament that the above referees are “Eligible Referees” as indicated above and that the stated competency levels are appropriate. Please ONLY sign if you are sure that ALL Referees listed are 2025 Registered, Certified, have completed all requirements, and can properly officiate a safe and fair game at the level indicated. Regional Referee Administrator Signature:__________________________________________
BE SURE TO DOWNLOAD PDF AND PRINT YOUR FORM AFTER SUBMISSION. ALL FORMS MUST BE PRINTED AND SIGNED. SIGNATURES MUST BE IN INK AND IT MUST BE ANY COLOR BUT BLACK OR THE FORMS MAY BE ESIGNED AS LONG AS THEY ARE MAILED IN WITH COMPLETE APPLICATION PACKAGE.
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