Clinic Request Host Form

Referee Clinic Request Host Form

Referee Clinic Request Form

The form below is only for organizations wishing to host a referee class/clinic. THIS FORM IS NOT TO REGISTER FOR A CLASS, TO REGISTER FOR A CLASS CLICK HERE:

Fields marked with a red asterisk (*) are mandatory.

Type of Clinic *
Hosting Organization *
Contact First Name *
Contact Last Name *
Contact Phone Number *
Location Name
Location Address
Contact E-mail *
First Date Requested *	-- Time: - -
Second Date Requested	-- Time: - -
Number of Participants Expected *
Clinic Fee*
Special Instructions

If you already have your personal ID enter it here:

...

Once you hit "Submit Query", an email is automatically sent to post your request on the Cal South website and to assign an instructor(s).

Medical Emergency/Release Forms are available here