EPSARC ENTRY LEVEL REFEREE FIELD SESSION REQUEST FORM
CONTACT NAME________________________________________________
CONTACT EMAIL _______________________________________________
CONTACT PHONE __________________________
SPONSORING ORGANIZATION____________________________________
DATE OF THE FIELD SESSION (SAT OR SUN ) _________________________
- THE DATE OF THE FIELD SESSION REQUEST SUBMISSION SHOULD BE 30 DAYS IN
ADVANCE OF THE FIELD SESSION DATE.
START TIME (SIX (6) HOUR MIN) __________________________________
FIELD OR GYM LOCATION:
ADDRESS _____________________________________________
CITY_______________________________ PA ZIP ___________
DIMENSIONS _________________________________________
CLASSROOM LOCATION
ADDRESS _____________________________________________
CITY_______________________________ PA ZIP ___________
AUDIO VISUAL ACCESS? PLEASE DESCRIBE_________________________
___________________________________________________________
LAVORATORY FACILITES AVAILABLE? _________________
WILL YOU NEED A CERTIFICATE OF INSURANCE (COI)? ___________________
IF THE ANSWER IS “YES” TO COI, THEN YOU WILL NEED A FACILITIES USE PERMIT
FROM THE OWNER OF THE FACILITY. THE DOCUMENT MUST STATE THE IDENTITY
THE OWNER, THE ADDRESS OF THE FACILITY, AND A WRITTEN DOCUMENT STATING
THAT YOU, THE CONTACT HAVE PERMISSION TO USE THAT SPECIFIC FACILITY FOR
THE PURPOSE OF REFEREE TRAINING ON THAT DATE.
ONCE ALL THIS IS COMPLETED AND ANY/ALL DOCUMENTS ARE COLLECTED, PLEASE SEND THIS
FORM BY SCAN TO MR. MIKE MORAN, SDI AT HIS EMAIL ADDRESS philapres@verizon.net.
CREATED 2/25/2025