Application for Registration as a Contest Official

Florida High School Athletic Association

Application for Registration as a Contest Ofcial

OF1

Revised 11/16

– 1 –

Instructions:

1. Type the form and complete EVERY item.

2. Returnapplicationandfeeto:OfcialsRegistrar,FHSAA,1801NW80thBlvd,Gainesville,FL32606-9176.

3. Toavoida$10latefee,applicationsforfallsportsmustbereceivedintheFHSAAOfcebyAug.18,

 wintersportsbySept.30,springsportsbyJan.3.

4. Youmustbeatleast18yearsoldtoregister(astudentofcialmustbeatleast16andllouttheOF1S form).

 •Applicationswithoutadateofbirthwillnotbeprocessed.

 •Applicationswithoutadaytimephonenumberande-mailaddresswillnotbeprocessed.

 •Applicationswithoutasportname,examsiteandlocalassociationFOREACHSPORTwillnotbeprocessed.

5. One(1)FHSAAStateSeriesPassismadeavailabletoeachregisteredofcialforpurchase.Thispasscosts$50andwilladmitthebeareronly,withproperID,

 admittancetoallDistrict,RegionalandFHSAAFinalsstatechampionshipcontestsinallsports.

For FHSAA Use Only

DateReceived:

AmountPaid:$

Thisapplicationisfor(checkone):First-TimeRegistrationRenewalofExistingRegistration

Name:_________________________________________________________________________________________________________________________________

E-mailAddress(required):_________________________________________________________________________________________________________________

DateofBirth:__________/__________/____________________ Five-DigitID#:_______________

Month Day Year

MailingAddress(street,routeorPOBox):___________________________________________________________________________________________________

City:_______________________________________________________ State:______ ZipCode:__________

DaytimePhoneNumber(required):(_______)_______–____________ Ext.:_________ CheckiffootballclockoperatorONLY

Sport Name of Local Association (do not abbreviate) Fee

1.____________________________________________  _______________________________________________________ @$46.00

Line1MUSTbeusedrst,regardlessofanypreviouslysubmittedapplications

2.____________________________________________  _______________________________________________________ @$27.00

3.____________________________________________  _______________________________________________________ @$27.00

4.____________________________________________  _______________________________________________________ @$27.00

 StateSeriesPass:Yes(paymentenclosed) @$50.00

For FHSAA Use Only

Latefee$10.00(ifapplicable) ......................... $_______.00

TOTAL (fees are non-refundable) ................ $ _______ .00

HaveYOUeverbeenarrestedforafelony?YouMUSTcheckone:YesNo

IfYES,checkONEofthefollowing: Iamenclosingcopiesofalldocumentationregardingmyarrest(s).

 Ialreadyhaveprovidedcopiesofalldocumentationregardingmyarrest(s).

Ifarrestedfor,orconvictedof,afelony,youmustsubmitapolice/courtreportverifyingreason,dateofarrest/conviction,andconclusionoftheincidentfollowedby

aletterofreferencefromeitherapersoninthejudicialsystemorlocalofcialsassociationofcer.

BymysignatureIacknowledgeandagreethatapprovalofmyapplicationWILLNOTconstituteanemploymentagreementbetweenmyselfandtheFloridaHighSchool

AthleticAssociationoritsmemberschools.Rather,Iwillactas,andbeconsideredtobe,anindependentcontractorwhileservingasanFHSAAregisteredofcial.Ialso

agreetobeboundandabidebyalloftheFHSAA’srulesandregulationsgoverningtheconductofcontestofcialsatFHSAAsanctionedevents.

By signing this document you will be obligated to take the FHSAA rules examination for each sport for which you register as a contest ofcial. Pursuant to the

Jessica Lunsford Act, it also will be necessary for each school or school district to check your name against the state and national listings of sexual offenders and

sexual predators.

Applicant’sSignature:_____________________________________________________________________________________Date:_____

_________________

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--- Applications without a signature and date will not be processed ---