Metrolina Area Soccer Referee Association Clinic Registration Form August 6, 2011 Providence Day School 7:00 AM to 1:00 PM
Date (Required, mm/dd/yyyy):
Last Name (Required): , First (Required): Middle: Email address (Required):
Date of Birth (Required, mm/dd/yyyy):
Years HS Experience: Years USSF Experience: Years NISOA (College) Experience:
Highest USSF Grade:
I will be attending the MASRA/USSF Physical Fitness Test? Yes No I would like my PFT results recorded for USSF Grade Maintenance or Advancement? Yes No I will have already completed my 2011-2012 PFT or I am temporarily injurred and can assist in conducting this test? Yes No
I will be attending the NCHSAA Required Clinic Saturday AM? Yes No
I will be attending the 2012 USSF 08 and 07 Re-Certification Clinic Saturday PM? Yes No
I understand that if I will be taking part in the MASRA Physical Fitness Test, I must in advance download the MASRA Physical Fitness Test Waiver of Liability Form from www.masra.net, must fill it out and sign it completely, and bring it with me Saturday, August 6, 2011. Yes No
I understand that if I am wishing to have my test results recorded by the NCSRA for grade maintenance or advancement, I must in advance download the USSF Physical Fitness Test Waiver of Liability Form from www.masra.net, must fill it out and sign it completely, and bring it with me Saturday, August 6, 2011 in addition to the required MASRA Waiver of Liability Form above (two completed forms). Yes No
I understand that the Physical Fitness Test will begin promptly at 7:00 AM and that I should bring proper hydration and clothing for this test. I understand that I should arrive at the track no later than 6:45 AM to register and warm up. I understand showers will be available following the PFT. I understand that I will not be allowed to participate without the proper filled out and signed form(s) as described above. Yes No
I would like the following topics included in the instruction and discussion of this year's High School clinics:
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