National Referees Committee

Grade 3 Referee Course Request Form

One months notice should be given for all course requests. While every attempt will be made to meet the proposed dates of courses, this is subject to availability of Tutors.

Course Details:

(Please provide 2 dates in order of preference)

1st Preference / 2nd Preference

Venue Details

(Please note a classroom environment and basketball court must be available)

Venue: / Address:
Contact Number

Co-ordinator Details

Name: / Address:
Phone: / Email:

Please indicate if there may be persons under the age of 18 attending the course:

Yes / No

All Course Participants must complete and return the Course Participant Form in advance of attending the course.

Under 18’s cannot participate in the course if the attached form is not returned to the Tutor in advance of the course starting.

Minimum Course Requirements:

  • Courses are limited to a minimum of 12 & maximum of 20 participants
  • A full basketball court should be available for a minimum of 50% of course
  • Classroom environment must be available with suitable desks and seating for all participants and Tutor

Facility Requirements

Can you please indicate if the following will be available at the venue?

Description / Available / Not Available / On Request
Full Size Court (with correct dimension)
Classroom with tables & Chairs
(for participants & Tutor)
Whiteboard/Chalkboard
Laptop Interface
Projector
Facility within 10 mins for Lunch
Basketball & Bibs

Participant Requirements

Participants should bring the following equipment:

  1. Completed Course Participant Form – signed by Parent/Guardian if U18
  2. Gym Gear
  3. Writing material (pen/paper),
  4. Rule Book (available to download from BI website)
  5. Lunch/Snacks

Additional Information

For all Grade 3 & Junior Officials Course a fee of €80 should be made payable to Basketball Ireland in order for participants to be registered as Referees.

In addition to costs evaluated for the organiser to facilitate this cost, €10 is required per participant (payable to the NRC) who will facilitate the provision of a ‘Yellow Whistle’ & Lanyard.

Signed: / Date:

Referee Course Participation Form

Please complete form in full and in BLOCK PRINT

Course Participant Personal Details
Name:
Address:
Telephone: / Home: / Mobile:
Email Address:
Date of Birth:

If your are Under 18 please ensure your Parent/Guardian completes the below section

Parent/Guardian Contact Information
Name:
Address:
Telephone: / Home: / Mobile (In case of emergency):
Email Address:

MEDICAL HISTORY AND INFORMATION:

Please provide details below of any known allergies, conditions, etc. that you suffer from and a brief description of steps that should be taken, including medication, in the event of an incidence of this condition during a session or game:

In the event of illness, I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners.

Signed:Date:

For Participants under the age of 18 the below must be signed be Parent/Guardian

Having parental responsibility I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners. If I cannot be contacted and my child needs emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication.

Signed:Date:

OTHER INFORMATION:

Any other special needs, requirements or directions that would be helpful for Tutors to know about

  • I confirm that all details are correct and I will inform the Tutor of any changes to the information above
  • I understand that as a parent/guardian of an underage participant it is my responsibility to ensure that my child(ren) travel safely to & from the venues as required

Signed:Date:

Please return completed forms to

“Recruiting, Developing & Retaining referees for current and future basketball needs in Ireland”

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