Lehigh Valley Softball Umpires - (Lehigh Valley, PA)

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2024 Lehigh Valley Umpires Registration

UMPIRE INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Cell Phone:

Home Phone:

* Email:

EMERGENCY CONTACT INFORMATION

* First Name:

* Last Name:

* Cell Phone:

* Email:

ACCIDENT & LIABILITY INSURANCE POLICIES are the sole responsibility of the undersigned.

The undersigned understands and acknowledges that the Lehigh Valley Softball Umpires is not his/her employer and therefore is not responsible for withholding federal and/or state income taxes or Social Security, etc. The undersigned is not entitled to receive Worker's Compensation coverage, or unemployment insurance and that his/her relationship with the Lehigh Valley Softball Umpires is that of an INDEPENDENT CONTRACTOR.

I Hereby Acknowledge reading and Ratify the ACKNOWLEDGEMENT OF INDEPENDENT STATUS. *

Yes, I have all clearances required by Pennsylvania Law *

No, I do not have all the clearances required by Pennsylvania Law

* Department of Human Services clearance (PA Child Abuse) (ACT151) - Effective Date:

* PA State Police clearance (ACT 34) - Effective Date:

* FBI clearance (ACT 114) - Effective Date:

New Umpires - Copies of clearances need to be emailed to Glenn Acker.

Existing Umpires - Email any updated clearances to Glenn Acker.

Glenn Acker email - glenn.acker@outlook.com

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