Form Pa 611 028 PDF Details

The PA 611 028 form serves a pivotal role in the regulation and oversight of combative sports within Washington State. This document, crucial for individuals seeking to either obtain or maintain their licensure to officiate at professional or amateur combative sporting events, requires annual submission to demonstrate proof of certification. The certification, as dictated by the form, must verify the individual's possession of adequate experience, skill, and training, qualifications that must be endorsed by an organization approved by the Department. By meticulously outlining the necessary qualifications and providing spaces for detailed assessments of the individual's abilities, the form ensures that only competent officials oversee combative sporting events. Moreover, it categorizes official capacities into several roles such as referee, judge, timekeeper, and inspector across different event types including pro boxing, pro martial arts, and amateur mixed martial arts. This systematic approach not only streamlines the licensing process but also enhances the safety and integrity of combative sports. The requirement for detailed evaluations of an individual's skill set, coupled with the inclusion of event-specific qualifications, underscores the Department of Licensing's commitment to maintaining high standards within the realm of sports. Furthermore, the form's provision for equal access underscores an inclusive ethos, ensuring that the application process accommodates all individuals equitably. Completed forms are directed to the Combative Sports Program, highlighting the specialized attention given to this sporting domain by the Washington State Department of Licensing.

QuestionAnswer
Form NameForm Pa 611 028
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesassessed, TTY, level 4 combatives, Certifying

Form Preview Example

Combative Sports Certification of Official

An individual wishing to be approved, or maintain his/her license, shall provide annual proof of certification as having adequate experience, skill, and training from an organization approved by the Department. (RCW 67.08.100)

When completed, send this form to:

Combative Sports Program, Department of Licensing, PO Box 9026, Olympia, WA 98507-9026 or fax to (360) 570-4956

I certify that I have assessed the experience and skill of

Name of individual

and this individual has adequate experience, skill, and training to be licensed in Washington State to perform in the following official capacity for professional or amateur combative sporting events.

Official capacity

Event type

Date training completed

Name of instructor

 

 

 

 

Referee

Pro boxing

 

 

 

 

 

 

 

Pro martial arts

 

 

 

 

 

 

 

Amateur mixed

 

 

 

martial arts

 

 

 

 

 

 

Judge

Pro boxing

 

 

 

 

 

 

 

Pro martial arts

 

 

 

 

 

 

 

Amateur mixed

 

 

 

martial arts

 

 

 

 

 

 

Timekeeper

Pro boxing

 

 

 

 

 

 

 

Pro martial arts

 

 

 

 

 

 

 

Amateur mixed

 

 

 

martial arts

 

 

 

 

 

 

Inspector

Pro boxing

 

 

 

 

 

 

 

Pro martial arts

 

 

 

 

 

 

 

Amateur mixed

 

 

 

martial arts

 

 

 

 

 

 

Describe in detail your assessment of the above individual’s skills, experience, and abilities to perform these duties, and provide specific examples:

PRINT or TYPE Certifying organization name

Address

City

State

ZIP Code

(Area code) Telephone number

PRINT or TYPE Name of authorized representative

Signature of authorized representative

X

Date

PA-611-028 (R/8/13)WA

We are committed to providing equal access to our services. If you need accommodation, please call (360) 664-6644 or TTY (360) 664-0116.

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