Clone of Verified Trainee Application

Certified Referee Application

Please fill out all the information below
Full Name (Same as Pickleball Canada membership)*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Pickleball Canada Membership #*
USA Pickleball Membership #
Locations where trained?*
City
Trainer's Name*
First and Last Name
Trainer's Email*
example@example.com
Trainer's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Location of ATS (Advanced Training Session) *
City
What date did you perform your ATS?*

MonthDayYear
Date
Who conducted your ATS?*
First & Last Name
ATS assessor's email address*
example@example.com
Number of matches refereed in the last 60 days*
Indicate tournament and date of matches in the last 60 days
Has your Regional Certified Referee Coordinator (CRC) contacted PC CR Admin to let them know that you are ready to be evaluated?*

YesNo
Most recent Referee test score*
Date last Referee test was taken*

MonthDayYear
Date
Most Recent Best Practices Score*
Date last Best Practices Test was taken*

MonthDayYear
Date
Most recent Line Judge test score*
Date last Line Judge test was taken*

MonthDayYear
Date
Attach a copy of your Visual Acuity Form*

Cancelof
Signature*
NOTE: Your signature verifies that the information provided is accurate and also acknowledges your agreement to comply with all applicable Pickleball Canada policies.
Should be Empty:

Certified Referee Application