Date: _______________
Name____________________________________________________
Email Address:____________________________________
*Required due to scheduling! Check it every Sunday to see the schedule for the week
Address: _____________________________________
_______________________________________
*Please use your permanent address so we can mail you your last paycheck.
Home phone: _____________________ Cell phone: ____________________
Birth date: _____________________
Current age: ____________________
Social Security Number: _____________________________________
*Used if you make over $600 for a season
What school do you go to? _______________________________________
What year/grade will you be starting in September? _____________________________
Have you worked for Hamburg soccer club before: ___________________________
Would you prefer to coordinate or referee? ________________________________
Any age group preference? ___________________________________
*Please note that these are personal preferences, not guarantees
Do you play for Hamburg Soccer Club? ____________________________
If yes, what team are you on? (Include team name, age group house or travel & coach name)
______________________________________________________________________
What nights are you available to work? ______________________________________
Comments: ________________________________________________________
___________________________________________________________________
Mail form to: Monarchs Referee/Coordinators, 780 Abbott Rd, Buffalo, NY 14220
*Questions? Please contact Lew Potter: directorofcoaching@hamburgsoccerclub.com
Phone (716) 989-9400