Junior Referee Clinic
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2015-16 ENTRY LEVEL REFEREE CLINICS IN THE W.O.A.A.
From: Don Shropshall, W.O.A.A. Referee Clinic Coordinator. (519) 482-3092 (H) [email protected]
This is an application for Entry Level Referee Clinics to be held for the 2015-16 season in the W.O.A.A. area. This application is to be used if you are a NEW official or returning to the program after letting your Referee certification lapse. DO NOT use this form if you have missed a Recertification Clinic
or are presently officiating. Registration will begin at 8:00 A.M., classes will begin at 9:00 A.M.
This is a four (4) hour in-class clinic. There will be NO on-ice session at the clinics this year.
REQUIREMENTS:
- There is a Hockey University e-learning prerequisite that MUST be completed prior to the day of the clinic. A certificate of your completed Hockey University e-learning must also be brought to the clinic with you. Failure to provide your certificate; you will be unable to participate in the clinic. All Entry Level clinic participates after registering and submitting payment to the Clinic Contact (as listed) will be given information how to obtain the online certificate.
- All candidates MUST provide a copy of a Police Record Check in a sealed envelope the morning of the clinic or a receipt from the police saying it is being processed, for attendance to be permitted. For ages 14-17 years, require a regular Criminal Records check and for 18 years and older require a Vulnerable Sectors Screening check.
- If you are 16 years of age or older, you MUST also do the Respect in Sports Activity Leader Course online and bring the certificate to the clinic as verification that you have completed it. You can access this course by going to www.omha.net and clicking on “CLINICS” on the right hand side of the screen and then scroll down the page to Respect In Sport section and click on RiS ACTIVITY LEADER PROGRAM for TEAM & GAME OFFICIALS.
Please bring a pencil and note pad to the clinic. Please complete the application form on the next page.
CLINIC COST REGISTRATION FEE (INCLUDES SNACKS, REFRESHMENTS AND HALL RENTAL)
14 AND 15 YEAR OLDS, AS OF DECEMBER 31 LEVEL ONE $135.00
16 AS OF DECEMBER 31, AND OLDER LEVEL TWO $185.00
COMPLETE APPLICATION FORM BELOW AND SEND TO CLINIC CONTACT WITH PAYMENT BY SUBMISSION DATE.
INDICATE WITH A CHECK MARK WHICH CLINIC YOU WISH TO ATTEND, PLEASE PRINT CLEARLY:
DATE OF CLINIC: LOCATION: SUBMIT APPLICATION & FEES BY:
SAT., OCT. 17, 2015 WALKERTON OCTOBER 9, 2015
(Sacred heart Catholic High School, 450 Robinson St., WALKERTON, ON)
MAKE CHEQUES PAYABLE TO: SOUTH BRUCE MINOR HOCKEY
CONTACT: John Turnbull, R.R. #3, WALKERTON, ON N0G 2V0
(519) 881-1404 (H) [email protected]
SUN., OCT. 18, 2015 GODERICH OCTOBER 9, 2015
(Goderich Kinsmen Centre, 185 Keays St., GODERICH, ON)
MAKE CHEQUES PAYABLE TO: GODERICH MINOR HOCKEY
CONTACT: Haley Stoll, Goderich Minor Hockey, c/o Jr. Referee Clinic Chair, Box 25,
GODERICH, ON N7A 3Y5
(519) 440-0311 (H), [email protected]
NAME:______________________________________________________________________________
STREET: ___________________________________ TOWN: _____________________________
(RURAL) 911 ADDRESS: ___________________________________________________________________
OR LOT: _____ CONC.: _____ TWSP: ______________________________
POSTAL CODE: ______________________
PREVIOUS ADDRESS (IF MOVED IN THE LAST 5 YRS):
PHONE NUMBER: ____________________
EMAIL: ________________________________
DATE OF BIRTH:__________________________
DAY/MONTH/YEAR
PRIVACY POLICY: “OPT-OUT” PROVISION:
The W.O.A.A. does not sell, trade or otherwise share the information we collect outside our association, however we may from time to time use the information for the purposes of offering additional services, promotions, including promotions offered by third parties. This type of usage of personal information by the W.O.A.A., its teams, leagues and/or programs is entirely at your discretion, should you choose NOT to allow this type of usage, please check the OPT-OUT box.
NOTE: By checking the OPT-OUT box above, your personal information WILL NOT be distributed outside our association.
Signature: ________________________________
Click Here for Downloadable Format of Application : mhrefclinicappentrylevel15-16.pdf