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         San Diego County Soccer Referees’ Association – 2012 Payment Receipt Form



As the Center Referee, I hereby certify that I was assigned to this game by the San Diego County Soccer
Referees’ Association and am authorized to collect the Referee Fees as listed below in Table A and specified in
Schedule A of the “Agreement for Services” between Your Club Name Here and the San Diego County Soccer
Referees’ Association.

                         All information on this form is being collected as a matter of record.



Team Gender Age B/G U-                         Coach                                   Manager

Presidio Game#                                 Game Date              /       / 2011            Game Time

Venue/Field



                                              Center Referee          Assistant Referee 1            Assistant Referee 2
Print Name Legibly
Sign Name
Did Not Arrive (no fee)                Showed / Did not Show         Showed / Did not Show          Showed / Did not Show
Arrived After Half-Time(no fee)        On Time / After Half-Time    On Time / After Half-Time       On Time/ After Half-Time

           SCHEDULE A                             YOUTH FEE SCHEDULE -- CASH ON THE FIELD

                                                      TWO                                             SUGGESTED
                     THREE REFEREES                                    ONE REFEREE
                                                    REFEREES                                        DENOMINATIONS
           U AGE     Referee      AR     AR        Referee     AR         Referee           $20s       $10s   $5s   $1s
            17-19      51         38     38          65        43           95                  4        3     2    7
            15-16      45         34     34          57        38           84                  4        3     1    8
            13-14      39         29     29          50        33           73                  3        1     3    12
            11-12      33         25     25          42        29           62                  3        1     1    8
             8-10      27         21     21          35        23           51                  2        1     3    4


                1. The home team pays the entire, exact game fee on the field to the referees before the
                   game starts (CASH -- NO CHECKS -- NO CHANGE)
                2. If the home team does not pay the referees, the game will not be played and the league
                   will be billed the game fee.
                3. If less than 3 referees are present at half time, the referees will refund the unused game
                   fee to the home team at the end of the game.
                4. A suggested number of bills to bring is listed above for your convenience. It will provide the
                   exact amount needed for each game.

				
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posted:11/5/2012
language:English
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