Referee Course 2017 Registration Form 110517

BASKETBALL ASSOCIATION OF SINGAPORE TECHNICAL COMMITTEE BASKETBALL REFEREE COURSE 2017

The Technical Committee of the Basketball Association of Singapore (BAS) would like to invite all interested individual to enroll in the Referee Course. You will learn the rules and know how to officiate basketball games. Upon completion of the Referee Course, you will be given opportunity to officiate in high-level local basketball games. In addition, you may be selected to attend FIBA Referee Clinic and upon successful completion, you will also be given opportunities to officiate in regional basketball game

Register now with BAS and maximize your potentials.

The details of the enrollment are as follow:

Date of Enrollment: 11 May 2017 – 1 June 2017 (Monday-Fridays, between 10am-6pm, closed on weekends)

Place of Enrollment: Singapore Basketball Centre 601 Aljunied Avenue 1 Singapore 389682 (Beside Geylang East Swimming Complex)

Duration of Course: 15 June 2017 – 7 July 2017 (All Lessons on weekdays from 7.30pm to 10.00pm) 15/6,16/6,19/6 & 21/6 Theory Lessons 22/6 Theory Exam 29/6,30/6,3/7,4/7,5/7 & 6/7 Practical Lessons 7/7 Practical Exam

Enrollment Fee: $225 (Singaporean/Permanent Resident) $350 (Non Singaporean/Non-Permanent Resident) $150 (Singaporean/Permanent Resident Poly/ITE/JC Students. Valid documents for verification must be shown during registration)

Enrollment Fee is Inclusive of course materials 1 FIBA Rule Book and 1 Whistle. Enrollment Fee must be paid either in cash (at BAS Admin Office) or by crossed cheque (made payable to “Basketball Association of Singapore”). A copy of NRIC is required for verification purpose.

Qualification: All male and female participants with the ages between 16 and 50 years of age and with minimum good knowledge of English and prepared to take up Referee assignment are most welcome.

Course Syllabus:  Theory – FIBA Rules 2014  Practical – 2 Persons and 3 persons Officiating  Fitness Assessment (minimum 50 laps beep test)  Mentorship Programme – 10 Practical Sessions & 10 Table Official Sessions

Venue: Singapore Basketball Centre

Medium of Instruction: English

Number of participants: Maximum 36 persons.

Contact Person: Chen Ting Fang (Pathway Manager – BAS) via email : [email protected] or Tel : 6743 8425/6341 6638 or Whats App : 8876 8618

Attendance: Participants are required to fulfill 80% of the total hours to be eligible to sit for the examination. A certificate of attendance will be presented to the successful candidates.

DISCLAIMER BAS reserves the rights to cancel, postpone or change the dates and venue of the course as it deems fit. BAS, its employees and agents will not be responsible for any death , injury or loss arising from any cause whatsoever in connect with the participant’s participation in the course. BASKETBALL ASSOCIATION OF SINGAPORE APPLICATION FORM BASKETBALL REFEREE COURSE 2017 DATE: 15 June 2017 – 7 July 2017

Name (As in NRIC/ Passport) PHOTOGRAPH

Name in Chinese Character ( If applicable )

Date of Birth Place of Birth Nationality

NRIC / Passport No Blood Group Sex * Male / Female Home Address

S’pore ( ) Profession Tel No. (Home) Hand Phone No.

Employer/ Unit

Place of Work / Address

S’pore ( ) Tel No ( Office ) Fax No ( Office ) Email Address :

Tee Shirt Size : Medical Conditions :

Physical Disability :

Please provide the following information: 1. Former basketball player Yes / No 2. Former basketball coach Yes / No 3. Former basketball team manager Yes / No 4. Attended similar clinic previously Yes / No Purpose of joining this course ______

Disclaimer:

I understand that all applications will go through a selection process by the Technical Committee and the Technical Committee has the right to reject any applications. Once selected, the non-refundable course fees will be paid before the start of the course. I certify that all the information in the application form is complete and true. The Technical Committee has the right to reject any application that is incomplete. I release the Technical Committee and any and all of their officers, conductors, co-coordinators, assistants from and against all claims, suits, actions, damages, costs, pecuniary loss, demands, liabilities, causes of action of every kind in law or in equity, attorney’s and other fees, expenses and compensation whatsoever, which I, my heirs or assigns and any and all other persons claiming rights by or through me may be able to asset, both now and at any time in future, known and unknown, foreseen and unforeseen , against the above in connection with my participation in the Referee Course 2017 including any act of skill. Said releases includes, but is not limited to, liability of and/ or from personal injury, death and/or property damages, which may in any way arise, in connection with or related to this activity, including acts of skills. Signature of participant and parent or guardian (participant under 18 years of age) indicates that all of the above has been read, understood and agreed.

Participant’s Signature Parent’s / Guardian’s Signature

------Name / Date : Name / Date : NRIC / Passport No : NRIC / Passport No :