New Referee Application Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number *Full Address *Date of Birth *Gender *MaleFemaleDo you have prior officiating experience? *YesNoIf yes – number of seasons prorHighest referee certification achieved. *123R3C4R4C5R5C6R6CHave you ever been suspended from refereeing? *YesNoIf yes – how long ago were you suspended?Within the last yearWithin the last 5 yearsMore than 5 years agoWhy were you suspended?Only complete if previous question was yetHave you every played hockey at any level? *YesNoWhat type of hockey did you play?CompetitiveRecreationalAt the highest level playedWhat was the highest level of hockey you played?Bantam, Midget, JuniorWhat was the highest level of hockey you played? (copy)Bantam, Midget, JuniorWhat was the highest level of hockey you played? (copy)Bantam, Midget, JuniorDo you have any coaching experience? *YesNoWhat type of hockey did you coachCompetitiveRecreationalAt the highest level playedCheckboxesFirst ChoiceSecond ChoiceThird ChoiceWhat caliber of hockey are you interested in refereeing? *Competitive Minor HockeyRecreational Minor HockeyMen’s Recreational HockeyCheck all that applyDo you live in one of the SRA core centres? *YesNoSRA core centres include Stratford, St Marys, Mitchell, Milverton and EmbroAre you willing to participate in SRA volunteer activities throughout the season? *YesNoProvide at least 2 references *Provide names and contact information for at least 2 references associated with hockey. You must include the name of the Association referee assignor if you have refereed previously1. Indicate all hockey organizations that you have cards for *Minor Hockey Alliance of OntarioOntario Minor Hockey AssociationOntario Women’s Hockey Association2. By checking the applicable boxes, I am certifying that I have, or will obtain before October 31, a card from each checked organization4. Alliance Hockey Level5. Ontario Minor Hockey Association (OMHA) Registration NumberOMHA Level7. Ontario Women's Hockey Association (OWHA) Registration NumberOWHA LevelWill you be officiating with other organizations in addition with SRA *YesNoList of other referee associations Fill in all other organization for whom you will officiate this seasonList days that you are available to officiate *MondayTuesdayWednesdayThursdayFridaySaturdaySundayCheck all that applyList any additional restrictions on your availability to refereeBy submitting this form as part of the application process to officiate with the Stratford Referees Association, I agree to abide by all provisions of the Association Constitution and Discipline policy. It is my responsibility to ensure that I have obtained cards for all the organizations listed above before October 31 The submission of this form does not guarantee acceptance as an official with the Stratford Referees Association. The Stratford Referees Association reserves the right to accept only those officials that are deemed to meet the standards of the Association *I agree to the terms and conditions stated aboveSubmit
