Request to Host a New Recreational Referee Field Clinic Please review the "DE SRC Requirements to Host an Entry Level Clinic" Entry Level Field Clinics are 4 hours and this form must be submitted 30 days prior to requested date. Proof of field/facility reservation must be provided when request form's submitted. Certificates of Insurance are the requester's responsibility. Request to Host a New Recreational Referee Field Clinic * REQUIRED FIELDS ARE IN RED TEXT * Your Name * Your Email Address * Your Phone Number * Date Of Clinic Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2020 2021 2022 * Time Of Clinic * Sponsoring Organization * Field Name/Number * Field Size Select Field Size Full Size Half Size Quarter Size * Field Address * Field City * State * Zip Additional Comments/Description Security Enter the number one in the box (as a numeral) I have read and agree to the terms of the "Entry Level clinic hosting requirements" and further state that a printed version of this form stands as the field permit for clinic date and time.