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Referee Registration Form

    PJYL Referee Registration Form

    Full name

    Contact email address

    Contact telephone number

    Alternative contact telephone number


    I confirm that I will be 18 years of age or more on the 1st August 2020

    Due to being 18 years of age or under please provide the following information:

    Date of birth of the young referee

    parent/guardian contact telephone number

    parent/guardian contact email

    Do you have a PJYL Badge?

    Current referee level

    How many years have you been at that level?

    Have you applied for promotion?

    Applied for level

    Do you have your own transport?

    Which League's did you officiate on last season? (If none, state 'none'.)

    Please indicate any known closed dates for August/September/October 2020

    Data Protection, Privacy Notice & Social Media Policy Statement:

    I give Potteries Junior Youth League permission in accordance with the Leagues Data Protection, Privacy Notice & Social Media Policies.

    I give authority for Potteries Junior Youth League’s Committee to store and administer the above provided information, as required to fulfil its operational duties in administering and manage the League’s Competitions.