Club Name Here

San Diego County Soccer Referees’ Association – 2015 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 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 / / 2015 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
YOUTH FEE SCHEDULE -CASH ON THE FIELD Showcase games each team $42.00 (1-20.00, 1-10.00, 1-5.00, 7-1.00)
THREE REFEREES / TWO REFEREES / ONE REFEREE / SUGGESTED DENOMINATIONS
U AGE / Referee / AR / AR / Referee / AR / Referee / $20s / $10s / $5s / $1s
17-19 / 52 / 40 / 40 / 67 / 44 / 98 / 4 / 4 / 2 / 2
15-16 / 46 / 35 / 35 / 59 / 40 / 87 / 3 / 3 / 5 / 1
13-14 / 40 / 31 / 31 / 52 / 34 / 76 / 3 / 2 / 4 / 2
11-12 / 34 / 26 / 26 / 44 / 29 / 65 / 3 / 1 / 3 / 1
8-10 / 28 / 22 / 22 / 36 / 24 / 53 / 2 / 1 / 4 / 2
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.