2. Personal Information

4. First Name*
5. Last Name*
6. Phone Number*
8. Email Address*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Drivers License Number*
17. Social Security Number*
19. Date of Birth
21. Month*
22. Day*
23. Year*

27. Sports Officials/Years of Experience

29. Please choose any sports you have experience officiating

    1. Basketball
    2. Softball/Baseball
    3. Flag Football
    4. Indoor Soccer
    5. Volleyball
31. Indicate the number of years you have officiating each sport. Leave blank if no experience in that sport.
33. Basketball
34. Softball/Baseball
35. Flag Football
37. Indoor Soccer
38. Volleyball

42. Availability

44. Please check all that apply. Weekdays will be in the evenings only and weekends will also include daytime.*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday

    1. Friday
    2. Saturday
    3. Sunday
48. Officials Agreement

    I hereby apply for acceptance to officiate in City- sponsored Athletic programs. In consideration of the acceptance of my application, I hereby, for myself, my heirs, executors and administrators agree as follows:

    • I agree to be compensated by the City of San Marcos for services rendered based on a pay scale established by the Parks and Recreation Department, and I agree to adhere to all policies and procedures of the Parks and Recreation Department.
    • I acknowledge and understand that if my application is accepted, I will perform services as an independent contractor, and not as an employee of the City of San Marcos.
    • I acknowledge and understand that programs of this nature involve risks of personal injury and property damage, and that as a prerequisite to register for a program of this nature, I am required to assume all such risks. 
    • I acknowledge and understand that the goal of the City of San Marcos Parks and Recreation Department is to facilitate safe and enjoyable programs for all participants; the City of San Marcos does not guarantee the safety of participants.
    • I knowingly and voluntary waive and release any and all rights and claims for any and all damages and injuries I may have against the City of San Marcos and its officers, agents and employees in connection with my services for the City of San Marcos Parks and Recreation Department.
    • I give permission to the City of San Marcos to use my photograph or image with or without my name for any and all purposes, including but to not limited to private or public presentations, advertising, publicity and promotional activity. I warrant that I have the right to authorize the foregoing uses and do hereby agree to hold the City of San Marcos Parks and Recreation Department harmless of from any and all liability of whatever nature which may arise out of result from such uses.
    • In the event of an accident or illness, I give permission to the City of San Marcos and its officers, agents and employees to obtain medical treatment for me that may reasonably appear to be necessary in the course of my participation in this program.
    • I verify that I am at least 16 years of age. 
50. Electronic Signature Acknowledgement and Consent

    I agree and understand that by signing below, that my electronic signature is the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.

52. Digital Signature*
53. Date*
    Date
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field