Certified Referee Renewal Application

Certified Referee Renewal 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 #
CR Credential Expiry Date
(Month and Year)
Estimate Number of Sanctioned Tournament Matches in the last 12 months
(including both Canadian and US)
List Sanctioned Tournament Names, Dates, and Venues.
Estimate # of Non Sanctioned Tournament Matches in the last 12 months
(including both Canadian and US)
List Non Sanctioned Tournament Names, Dates, and Venues.
Number of matches with Line Judges
Estimate total # of matches with Second Referee (as lead or second).
Date of most recent Referee Rules Test

MonthDayYear
Date
Score of most recent Referee Rules Test
Date of most recent Best Practices Test

MonthDayYear
Date
Score of most recent Best Practices Test
Date of most recent Line Judge Test

MonthDayYear
Date
Score of most recent Line Judge Test
Date of most recent Player Rules Review

MonthDayYear
Date
Score of most recent Player Rules Review
Have you mentored any referees in the last 12 months?
If yes, please list the first and last names of the individuals
Have you assisted with training or assessing in the last 12 months?
If yes, please list the the locations
Have you participated in other Pickleball Referee related activities in the last 12 months? Examples include: Served as a tournament director or tournament referee coordinator, served on a Canadian Pickleball national or regional committee.
If answered yes above, please specify which activities
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.
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