Roxbury Soccer Club

* First Name:

* Last Name:

* Address:

Address 2:

* City:

* State:

* Zip Code:

* Primary Phone (Format xxx-xxx-xxxx) Please make sure that this is a phone that you can easily be reached.:

* Primary Phone Type:

Cell Phone

Home Phone

Secondary Phone (Format xxx-xxx-xxxx):

Secondary Phone Type:

Cell Phone

Home Phone

* Cell Phone Carrier:

* Primary e-mail address (to be used as your Arbiter login, and must be unique to Arbiter) Please make sure that this e-mail address is checked regularly.:

* Secondary e-mail address:

* Age as September 1, 2024:

* Date of Birth:

* Do you have a travel, HS sports, or marching band commitment for the Fall 2024 season:

* Is your referee certification current for 2024?:

* Referee Certification Level:

* What is the highest level that you have refereed?:

I understand that if I fail to respond to 2 Arbiter game assignments, I may not receive further assignments at the discretion of the Referee Coordinator (check this box to confirm that you have read and agreed to this statement). *

I understand that if I fail to keep my Arbiter Blocks up to date, I may not receive further assignments at the discretion of the Referee Coordinator (check this box to confirm that you have read and agreed to this statement). *

I understand that if I do not input blocks in Arbiter and decline 2 assignments, I may not receive further assignments at the discretion of the Referee Coordinator (check this box to confirm that you have read and agreed to this statement). *

I certify that my referee certification is valid for the 2024 season and that I have the required valid referee patch to display on my uniform. Failure to display a valid patch may result is being dismissed as a referee. *

I understand that I am bound by the Roxbury Soccer Club's Code of Conduct. If I violate that Code, I may be removed as a referee. *

Additional Comments - Use this field for additional contact information or details:

OUR SERVICES

LOCAL SPORTS

ELITE

Referee Registration - Fall 2024