NOTE: REQUIRED FIELDS ARE MARKED WITH (*)
Officials Name: *
(first) (last)

Address:*

Town:*

Zip Code:*

E-Mail Address:*

Primary Contact Phone w/area code:*

Secondary Contact Phone w/area code:

Other Contact Phone w/area code:

Number of Years as Certified Official:*

Select Home School District:* Babylon Village Bay Shore Bayport-Blue Point Center Moriches Commack Comsewogue Connetquot Copiague Deer Park East Hampton East Islip East Moriches Eastport- Hauppauge Islip Kings Park Lindenhurst Longwood Middle Country Miller Place Mt. Sinai North Babylon North Fork North Shore Patchogue/Medford Rocky Point Sachem Sayville Shoreham- Smithtown South Counrty South Huntington South Manor South Shore SYAG Three Villages Wading River West Babylon Westhampton Beach Riverhead

List any school(s) to which you should not be assigned:

School 1: School 2:

School 3: School 4:

Do you want to be scheduled as a SCGL Referee? *
YES NO

How many consecutive games are you willing to work in 1 day?

Please call me on an AS NEEDED BASIS ONLY *
YES NO

Date	Earliest Start Time AM/PM?	Latest Start Time AM/PM?
Saturday, March 26th Wounded Warrior
Sunday, March 27th Wounded Warrior
Sunday, April 3rd
Sunday, April 10th
Sunday, April 17th
Sunday, May 1st
Sunday, May 8th
Sunday, May 15th
Sunday, May 22nd
Sunday, June 5th
Saturday, June 11th SCGL Jamboree - All Day
Sunday, June 12th Rain Make Up Date

Once you receive your schedule you must confirm your acceptance of games.
Check the SCGL web site for ALL weather related cancelations.
This is YOUR responsibility.
DUE BY: MARCH 22nd



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