Application Form for Officials

BC Athletic Commissioner
- AMATEUR OFFICIAL REGISTRATION
(Referee, Judge, Scorekeeper or Timekeeper)
for Amateur Combat Sport Events
APPLICATION PACKAGE
This application package contains information on obtaining a three (3) year registration as an official for amateur
combat sport events in the Province of British Columbia.
There are six (6) steps to obtaining an official’s registration:
Step 1 Take or have taken two (2) passport style photographs (i.e. headshot against plain background) of
yourself, these can be taken by a professional or at home, using a digital camera, smart phone or similar
device, and sent via email.
Step 2 Visit your local police authority to obtain a Criminal Record Check (CRC) including a vulnerable sector
check (Tier 4). For information on the process and requirements in Canada, please visit:
http://www.rcmp-grc.gc.ca/cr-cj/fing-empr2-eng.htm. You are responsible for all associated fees. Your
CRC will remain valid with this office for three (3) years.
Step 3 If applying as a referee or judge, obtain a copy of your Certification from an Association of Boxing
Commissions endorsed training course(s) or other relevant training course(s) that you have successfully
completed and that are specific to the registration type for which you are applying.
Step 4 Make a copy of two (2) pieces of personal identification, one that has your photo and is government
issued (example: passport, driver’s licence) – check that the copy shows your picture clearly.
Step 5 Complete the official’s Registration Application in full ensuring all required signatures are present.
Step 6 Forward the following documents to the Office of the Athletic Commissioner:
 Your completed Registration Application
 Criminal Record Check result
 Declaration of Criminal Offences form
 Certification from an Association of Boxing Commissions endorsed training course(s) or other
relevant training course(s)
 Clear copies of two (2) pieces of personal identification, one (1) of which has your photo and is
government issued (example: passport, driver’s licence)
 Two (2) passport style photos
As processing times vary, ensure you submit your application as soon as possible.
Office of the BC Athletic Commissioner
Mailing Address:
Courier/Drop Off Address:
th
PO Box 9823 Stn Prov Govt
5 Floor, 800 Johnson street
Victoria, BC V8W 9W3
Victoria, BC V8W 1N3
Phone: 250-952-6735 (in Victoria) or 1-855-952-6760 (toll free) Fax: 250-387-8703
www.cscd.gov.bc.ca/bcathleticcommission
Email: [email protected]
Keep a copy of your application and supporting
documents for your records
Amateur Official Registration Kit/Nov 2014
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BC Athletic Commissioner
- AMATEUR OFFICIAL REGISTRATION
(Referee, Judge, Scorekeeper or Timekeeper)
for Amateur Combat Sport Events
TERMS AND CONDITIONS
The following terms and conditions apply to every registration, including registration for officials:

The registration holder must:
(a) promptly report to the Commissioner if he/she has been charged with an offence, or
(b) report to the Commissioner within 14 days of its occurrence if he/she has been convicted of an offence
under a B.C. act or a law enacted by the Government of Canada, another province of Canada or a foreign
jurisdiction. Failure to do so may result in your registration being declared void.

The registration holder must comply with:
o any terms and conditions imposed on the registration by the Commissioner.

The registration holder must carry, or have available, the registration at all times when engaged in the
activity the registration authorizes.

The registration holder, when engaged in the activity the license authorizes, must produce the registration
on the request of a peace officer or the Commissioner.

The registration holder must report to the Commissioner, within 14 days after its occurrence, the following:
o the theft or loss of a registration;
o a change in an address required by the application for the registration.
Duties of Officials
An official must not appear as an official for an event under the influence of a substance that could impair his or
her judgment in performing his or her official duties.
Officials such as referees may be subject to a pre event medical check by a ringside physician attending the
event.
Amateur Official Registration Kit/Nov 2014
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BC Athletic Commissioner
- AMATEUR OFFICIAL REGISTRATION APPLICATION
(Referee, Judge, Scorekeeper or Timekeeper)
for Amateur Combat Sport Events
A. REGISTRATION TYPE
Check each box indicating the type of registration for which you are applying and (for judge and referee
applications) in which disciplines:
 Judge
 Referee
 Kickboxing
 Kickboxing
 MMA
 MMA
 Muay Thai
 Muay Thai
 Pankration
 Pankration
 Scorekeeper
 Timekeeper
B. APPLICANT INFORMATION
Legal name:
Surname
Address:
Street
First Name
Middle Name
City
Prov/State
Country
Postal Code/ZIP
Mailing address:
(if different from
above)
Street
City
Prov/State
Country
Postal Code/ZIP
Telephone
number:
Email address:
Home (xxx-xxx-xxxx)
Cell (xxx-xxx-xxxx)
Other (xxx-xxx-xxxx)
Date of birth:
(yyyy-mm-dd)
Country of
citizenship:
Sex:
 Male
 Female
C. OTHER JURISDICTIONS WHERE THE APPLICANT HOLDS A SIMILAR REGISTRATION TO THAT BEING
APPLIED FOR AT THIS TIME
List the jurisdictions in which you hold or have a held a similar registration to that being applied for.
Name of Jurisdiction
Registration #
Expiry Date
Amateur Official Registration Kit/Nov 2014
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BC Athletic Commissioner
- AMATEUR D. EXPERIENCE
List your experience officiating in the areas for which you are applying for a registration, including providing a list
of locations and dates where you officiated a boxing, kickboxing, MMA, muay thai or pankration event. Use a
separate sheet if necessary.
E. STATEMENT AND DECLARATION
I acknowledge that the following personal information may be collected by the Athletic Commissioner or his or
her delegate under the authority of sections 26(a) and 26(c) of the Freedom of Information and Protection of
Privacy Act:
(i)
Contact information including name (and any alias or stage name), complete residential and
mailing address and an email address if applicable, day time telephone number, date of birth,
and country of citizenship and sex;
And if applicable:
(ii)
(iii)
(iv)
Criminal record check or police record check;
Credit Check;
Medical information related to examinations conducted by ringside physicians prior to, during or
after an event; and
Information related to my conduct prior to, during, and after an event.
(v)
I authorize the personal information to be collected by the Athletic Commissioner in the above manner and I
further hereby consent to:
(i)
the use of the personal information as applicable to the registration I am applying for by the Athletic
Commissioner for the following purposes:
a)
b)
Processing this registration application and determining my suitability for the registration
being sought;
Enabling the Athletic Commissioner to verify my personal information and perform
Amateur Official Registration Kit/Nov 2014
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BC Athletic Commissioner
- AMATEUR -
c)
background checks prior to the registration or issuance of a registration or permit; and
Enabling the Athletic Commissioner to regulate and enforce professional boxing and
professional mixed martial events governed by the BC Athletic Commissioner;
(ii) the disclosure of, and status of any suspension or disciplinary action imposed on me by the Athletic
Commissioner to the Association of Boxing Commissions (ABC) and through that body, other ABC
affiliated athletic commissioners or similar organizations in other jurisdictions that regulate
professional boxing and professional mixed martial arts;
(iii) the disclosure of any or all of the information supplied to BCAC to Salesforce.com Inc. and it affiliates
in the United States of America to be stored on behalf of the Athletic Commissioner and that such
information may be made public on their websites;
I certify that I have read and understand the content of this Consent form with respect to the collection, use
disclosure, and storage of my personal information in relation to my application for this registration.
This consent is valid from the date signed unless I revoke my consent by writing to the Athletic Commissioner at
the address specified below.
For questions regarding the collection of personal information please contact the BC Athletic
Commissioner at 250‐952‐6735 (in Victoria) or 1‐855‐952‐6760 (toll‐free).
Queries by mail may be directed to:
And by Courier to:
Office of the BC Athletic Commissioner
PO Box 9823 Stn Prov Govt
Victoria BC V8W 9W3
Office of the BC Athletic Commissioner
5th Floor, 800 Johnson St.
Victoria, BC V8W 1N3
(yyyy-mm-dd)
Signature:
Date
F. STATEMENT AND DECLARATION
I certify that all of the information provided by me in this application is true to the best of my knowledge and
belief.
I understand that any false or inaccurate statements made by me in this application for licensing or failure to
disclose may be deemed sufficient cause for rejection of my application by the Commissioner or his or her
delegate.
I understand that any false or inaccurate statements made in this application for licensing that may be revealed
following me being issued a registration could result in the suspension or cancellation of my registration.
I certify that I have read and understood the “Standard Terms and Conditions for Officials”, including the “Code
of Ethics and Conduct for Officials”. I further certify that I will not appear as an official at an event under the
influence of a substance that could impair my judgment in performing my official duties.
(yyyy-mm-dd)
Signature:
Amateur Official Registration Kit/Nov 2014
Date
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