New Haven Football Officials Association

247 Bayard Avenue
North Haven, CT 06473

(203) 230-4513

Name_________________________________________________

Address_______________________________________________

City________________________________ Zip___________

Based upon a physical examination, which I have personally conducted,

I hereby certify that the above named individual is physically

qualified to officiate high school football for the 2006 football

season.

Dated this ________ day of __________ 2006.

______________________________________________________________________________

Physician's Signature and Stamp

Physical is due August 1,2006, postmarked no later than July 31,2006.

Please return to:

Steve Narracci

247 Bayard Ave.

North Haven, CT 06473

Dated this day of 2006.

________________________________________________________________________
Physician's Signature and Stamp

Physical is due August 1,2006, postmarked no later than July 31,2006.

Please return to:
Steve Narracci
247 Bayard Ave.
North Haven, CT 06473

______________________________________________________________________________
Physician's Signature and Stamp

Physical is due August 1,2006, postmarked no later than July 31,2006.

Please return to:
Steve Narracci
247 Bayard Ave.
North Haven, CT 06473

Physician's Signature and Stamp

Physical is due August 1,2006, postmarked no later than July 31,2006.

Please return to:
Steve Narracci
247 Bayard Ave.
North Haven, CT 06473

Dated this ________ day of __________ 2006. ______________________________________________________________________________ Physician's Signature and Stamp Physical is due August 1,2006, postmarked no later than July 31,2006. Please return to:Steve Narracci247 Bayard Ave.North Haven, CT 06473

______________________________________________________________________________ Physician's Signature and Stamp Physical is due August 1,2006, postmarked no later than July 31,2006. Please return to:Steve Narracci247 Bayard Ave.North Haven, CT 06473

Physician's Signature and Stamp Physical is due August 1,2006, postmarked no later than July 31,2006. Please return to:Steve Narracci247 Bayard Ave.North Haven, CT 06473

Dated this day of 2006.

________________________________________________________________________
Physician's Signature and Stamp

Physical is due August 1,2006, postmarked no later than July 31,2006.

Please return to:
Steve Narracci
247 Bayard Ave.
North Haven, CT 06473

______________________________________________________________________________
Physician's Signature and Stamp

Physical is due August 1,2006, postmarked no later than July 31,2006.

Please return to:
Steve Narracci
247 Bayard Ave.
North Haven, CT 06473

Physician's Signature and Stamp

Physical is due August 1,2006, postmarked no later than July 31,2006.

Please return to:
Steve Narracci
247 Bayard Ave.
North Haven, CT 06473