Umpire Compliance Form Please fill out the form below. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of Umpire *FirstLastUnder 18's Only Date of Birth (dd/mm/yyyy) *EN Membership Number *Is your primary membership through Essex Thurrock {SETNA} *YesNoOfficiating Qualification Held *INTO OfficiatingIO, but actively working towards a C AwardC AwardB AwardA AwardPlease note to be considered as actively working towards a C Award you must meet the following criteria : - Have attended the virtual C course and it's still valid - Have passed the written paper - Are being actively mentored by a named mentorDate Qualification was Awarded (dd/mm/yyyy} *Please confirm the date that you attended the new rules game management workshop (dd/mm/yyyy) *Contact Number * Number before SETNA Email Address *Do you have any protected characteristics that you would like to declare ? *YesNoPrefer not to sayI give my consent for the following :- *Images in video and/or photographic form appearing on the SETNA Website/social media pagesIdentification documents to be held if necessary by SETNAHealth and medical information to be held by SETNA for the purpose of Health and SafetyBy returning this completed form, I agree to taking part in the activities of SETNA/Essex Thurrock. I understand that when a member provides SETNA with personal information about other individuals, SETNA relies on that member to make the individual aware that the information has been provided to SETNA and for what purpose, and to whom it may be disclosed and also how they can access their information. I also confirm that I will not forward any documentation, which contains personal information of other clubs. Should I be required to, I will seek prior written approval from the SETNA Data Protection Officer (SETNADPO@hotmail.com) before sending. *YesI wish to be included on the Umpires List and agree to the sharing of the above information with Team Secretaries, Alternative Contacts, the SETNA Committee and England Netball. *YesNoUnder 18's form completed by, and relationship to Umpire *Submit
