phone (408) 924-6266
REQUEST FOR SPORT OFFICIALS
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ALL REQUESTED INFORMATION MUST BE PROVIDED, OR REQUEST WILL BE AUTOMATICALLY DECLINED
Person making request:
FOR ASCR OFFICE USE ONLY
Phone:
Date Received:
Received By:
Email:
Organization hosting event:
Name of event:
APPROVED
DECLINED
If declined, reason(s):
Date(s) of event:
Times of event:
Location of event:
Street address:
City:
Person in charge on-site for officials to report to:
Cell phone:
SPORT(S) TO BE OFFICIATED
Sport # 1:
Sport # 2:
Number of courts/fields:
Number of courts/fields:
Requested # of officials per game:
Rules different from IM Sports:
Requested # of officials per game:
Rules different from IM Sports:
Duration of each game:
Duration of each game:
Sport # 3:
Sport # 4:
Number of courts/fields:
Number of courts/fields:
Requested # of officials per game:
Rules different from IM Sports:
Requested # of officials per game:
Rules different from IM Sports:
Duration of each game:
Duration of each game:
Additional Notes:
Date:
Director of Officials’ Signature:
Additional Notes:
IMPORTANT – PLEASE READ
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COMPLETING THIS REQUEST DOES NOT GUARANTEE THAT OFFICIALS WILL BE
PROVIDED. WHEN THIS COMPLETED FORM IS RECEIVED IN THE ASCR OFFICE, A
REQUEST WILL BE SENT OUT TO IM SPORTS OFFICIALS BASED ON THE INFORMATION
PROVIDED, AND A RESPONSE WILL BE ISSUED TO THE REQUESTING PERSON IN AS
TIMELY A MANNER AS POSSIBLE.
PER GAME RATES FOR OFFICIALS:
 CONTESTS THAT ARE SCHEDULED TO LAST ONE HOUR OR LESS
= $12 PER GAME PER OFFICIAL
 CONTESTS THAT ARE SCHEDULED TO LAST LONGER THAN ONE HOUR
= $16 PER GAME PER OFFICIAL
OFFICIALS ARE TO BE PAID BEFORE THEY BEGIN OFFICIATING THEIR FIRST GAME
OFFICIALS WILL NOT BE HELD RESPONSIBLE FOR ANY CONFLICTS OR
CONFRONTATIONS THAT ENSUE DURING OR BETWEEN CONTESTS, AND ARE
INSTRUCTED TO LEAVE THE EVENT IF ANY HEATED VERBAL OR PHYSICAL CONFLICTS
ARISE
EACH EVENT MUST HAVE A SUPERVISOR OFFICIALS WILL REPORT TO AND WHO WILL
HANDLE ANY EVENT CONFLICTS WHICH ARRISE.
Please read and initial each of the following items, and print and sign your name below.
_____ (INITIALS) I UNDERSTAND THAT COMPLETING THIS REQUEST DOES NOT GUARANTEE
THAT OFFICIALS WILL BE PROVIDED.
_____ (INITIALS) I AGREE TO HAVE THE OFFICIALS PAID BEFORE THEY BEGIN THEIR FIRST
GAME, WHEN THEY ARRIVE AND CHECK IN WITH THE PERSON LISTED AS “IN-CHARGE”
ON THIS FORM.
_____ (INITIALS) I UNDERSTAND THAT OFFICIALS WILL NOT BE HELD RESPONSIBLE FOR ANY
CONFLICTS OR CONFRONTATIONS THAT ENSUE DURING OR BETWEEN CONTESTS,
AND ARE INSTRUCTED TO LEAVE THE EVENT IF ANY HEATED VERBAL OR PHYSICAL
CONFLICTS ARISE.
_____ (INITIALS) I UNDERSTAND THAT A.S. CAMPUS RECREATION DISCOURAGES THE
IMPLEMENTATION OF RULES THAT ARE DIFFERENT FROM SJSU IM SPORTS LISTED
SPORT RULES, AND ACCEPT ALL RESPONSIBILITY OF ANY ROUGH PLAY THAT ARISES
FROM ANY RULE CHANGES MADE FOR THIS EVENT.
I, ____________________________________, HEREBY AGREE TO ADHERE TO THE ABOVE
(printed name)
LISTED TERMS AND CONDITIONS OF HIRING AND/OR USING SAN JOSE STATE INTRAMURAL
OFFICIALS’ ASSOCIATION OFFICIALS.
__________________________________ ___________
(signature)
(date)
PLEASE COMPLETE ALL SECTIONS OF THIS FORM AND SCAN AND EMAIL TO
[email protected], OR RETURN TO THE Campus Recreation office at the Sport Club.
You may also FAX this form to (408) 924-6231.