Referee Request Form
(complete all required fields)
Your Name
*
First Name
Last Name
Your Club Affiliation
*
Your Email
*
example@example.com
Your Phone Number
*
-
Area Code
Phone Number
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Is this a match or tournament?
*
Match
Tournament
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Date of match/tournament
*
-
Month
-
Day
Year
Date
Date Picker Icon
Time of match/tournament
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Opponent or Tournament name
*
Match/Tournament location
*
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Level of match
*
Men's D1
Men's D2
Men's D3
Men's Open
Women's D1
Women's D2
Women's Open
College Men's D1A
College Men's D1
College Men's D2
College Men's D3/NSCRO
College Women's D1
College Women's D2
Boys u18/Varsity
Boys u16/JV
Boys u14
Girls u18/Varsity
Girls u16/JV
Girls u14
If you need Assistant Referees, indicate how many:
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Adult or Youth tournament
*
Adult
Youth
Type of tournament
*
15-a-side
7-a-side
How many teams?:
*
How many matches?:
*
How many fields?
*
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Description of match and other information
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Terms of Submission
*
By checking this box, I acknowledge that I understand I will be billed by SCRRS for this match, and that any request made in 7 days or less of the event will be subject to a $50 charge. A 10% late fee will be added for every 30 days payment is past due of the date of the invoice.
By checking this box, I agree that my club meets all USA Rugby registration requirements including eligible players and coaches. In addition, I agree to the establishment and maintaining of the play enclosure area, including barriers and technical zones (if applicable). I acknowledge that failure to ensure these requirements may result in sanctioning by my governing body
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