EmailMe Form - Referee Fitness Training/Testing Required Waiver

Referee Fitness Training/Testing Required Waiver

Referees upgrading to Regional Referee license, maintaining Regional Referee certification or preparing for National Candidacy must pass the fitness test requirement for certification level each year.

Referees wishing to obtain Premium Pay Tier 3 must pass a modified version of the Regional Referee Fitness Test.

Referees must pre-register for testing/training dates through the Colorado Referees Registration portal (OMS). After registration, this waiver must be completed or you will not be allowed to participate.

Fees are non-refundable.

Name *
First Last
Date of Birth *
Email *
Phone *
### - ### - ####
Current Referee Grade *
Emergency Contact Name *
First Last
Emergency Contact Phone *
### - ### - ####
Agreement and Release of Liability
Physical Activity Release of Liability Form
I hereby acknowledge my voluntary participation in the physical activities of the Colorado Referee Program and that such activities may involve the following; Referee Fitness Testing, Aerobic Endurance, Sprints, Interval Runs, and on soccer field training activities.
Agreement and Release of Liability *
Agree
Assumption of Risk
I have been informed and understand that my participation in the aforementioned activities may expose me to certain foreseeable and unforeseeable risks of damage and/or bodily injury, may be potentially hazardous, even life threatening, activities may result in serious bodily injury, where I may need to be hospitalized. I am voluntarily participating in these activities. With knowledge of the dangers involved, and I hereby agree to accept any and all risk of injury or death, and verify this statement by signing below.
I hereby agree that I, my assignees, heirs, and legal representatives will not make a claim against or sue Colorado Referee Committee. I hereby release the Colorado Referee Committee, officers, directors, employees, agents, volunteers, successors, collectively the Sponsors for events, for injuries or damages resulting from participation in testing and other physical activities. I hereby, waive and release each and all of the above named Sponsors for events from any and all liability arising out my participation of the above mentioned activities and hereby waive my rights herein to assert any claim(s) for damages, bodily injury or serious bodily injury to the fullest extend allowed by law.
Assumption of Risk *
Agree
I have carefully read this agreement and fully understand its contents, and I hereby execute this Physical Activity Release of Liability Form. Check one of the following: *
I am over the age of eighteen (18)
I am an emancipated minor
I am under age eighteen (18) years; the signature of my parent or legal guardian is provided below.
Participant Signature *
Clear
Required for Minors: (18 or younger)
I am the parent or legal guardian of the above name referee
I have read and understand the entire Agreement and Release from Liability set forth above;
On behalf of the named referee, myself, & any other parent of the referee, I knowingly assume the risks described above, I waive & release actions, claims & demands as described above & I knowingly & voluntarily enter into this Agreement
Parent/Guardian Name
First Last
Parent/Guardian Signature
Clear
Medical Conditions / Information Provided to Medical/Athletic Training Staff
This information is requested so that medical and athletic training staff may better assist you in the event of an emergency.

Individuals who have cardiovascular symptoms, such as exertional chest pain, exertional syncope or presyncope, palpitations, new or excessive shortness of breath, or exertional fatigue, should be evaluated by a physician for medical clearance before fitness testing participation.

Patients with an identified cardiac disorder, unexplained symptoms, or previous sudden death events should be cleared by a cardiologist before fitness testing is considered.

All testing personnel should be aware of which athletes have sickle cell trait, asthma, high blood pressure, any allergies with anaphylaxis, or any other medical condition in case an emergency arises.
Please indicate any medical conditions or cardiovascular symptoms you have: *
Referee Name
First Last
Signature

By signing this form, you acknowledge that you have disclosed any known medical conditions or cardiovascular symptoms that you have experienced or been diagnosed. *
Clear
Date Time *
MM / DD / YYYY
All referees attending for training or test must plan accordingly to arrive minimum 15 minutes prior to posted start time listed below. Do not arrive after scheduled start time.

Test Requirements here:
http://www.coloradoreferees.com/blogs/fitness_testing/

Training Downloads including MP3 of interval audio: https://ussoccer.app.box.com/s/ezycdrijrly73i9kbbxm/folder/11593986775

Regional Referees (FIFA Women's Category 1)
75/25 meter intervals (17/20 sec)
40 meter sprint - 6.4 sec x 6 reps

National Referees
Male: 75/25 meter intervals (15/18 sec)
40 meter sprint - 6.0 sec x 6 reps

Female: 75/25 meter intervals (17/20 sec)
40 meter sprint - 6.4 sec x 6 reps

Agreement and Release of Liability

Assumption of Risk

Medical Conditions / Information Provided to Medical/Athletic Training Staff