New Zealand Inline Hockey Probationary Level 1 Referee Record of Games Verification www.inlinehockeynz.org.nz Name: Address: Date
Mobile: Venue
Game #
Age Grade
Team (Home)/ Team (Away)
Scorer
Other Referee
1 2 3 4 5 6 7 8 9 10 11 12 The above record is a true and accurate record of my officiating duties. Probationary Referee Signature:
Date:
POINTS TO REMEMBER: 1. To achieve your level 1 referees certification you are required to have officiated in a minimum of 12 games. 2. Having done this you need to send this form to the NZIHA Chief referee who will then arrange for your referees ID card and badge to be sent to you. 3. Have the scorer and the other referee verify your officiating. 4. Sign the form and email a scan to Derek McLean at
[email protected]. If you are unable to scan contact Derek for his postal address. 5. Please retain the original for your records.
New Zealand Inline Hockey, P.O.Box 18001, Merrilands, New Plymouth, NZ
