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Supplemental Report Form
First name
*
Last name
*
Email
*
Phone
*
USSF Affiliated Game
*
Yes
No
Arbiter Game #
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Select League
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SOCAL/NPL
ECNL/ECRL
GA
EA/EA2
DPL
Club Premier
San Clemente Coed
LNFA
City of Irvine
Tournament
If Tournament, Enter Tournament Name
Game Date
*
Month
Day
Year
Scheduled Kickoff Time
*
Time
:
Hours
Minutes
AM
Venue/Field (Example: OC Great Park #7)
*
Gender
*
Male
Female
Coed
Age Group
*
Adult
U18/U19
U17
U16
U15
U14
U13
U12
U11
U10
U9
U8
U7
Home Team
*
Away Team
*
Home Team Score (Final)
*
Away Team Score (Final)
*
Center Referee Name
*
Center Referee Grade
*
Grassroots
Emeritus
Regional
National
Center Referee USSF ID # (Last 4 Digits)
*
AR1 Name
*
AR1 Grade
Grassroots
Emeritus
Regional
National
AR1 USSF ID # (Last 4 Digits)
AR2 Name
*
AR2 Grade
Grassroots
Emeritus
Regional
National
AR2 USSF ID # (Last 4)
Yellow Card/Caution
Caution 1 Player/Coach Name
Caution 1 Team & Jersey #
Reason for Caution 1
Unsporting Behavior (UB)
Persistent Infringement
Delaying Restart
Dissent
Leave/Enter Field Without Permission
Fails to Respect Required Distance
Stopping Promising Attack (SPA)
DOGSO (Attempting to Play Ball in Penalty Area)
Caution 2 Player/Coach Name
Caution 2 Team & Jersey #
Reason for Caution 2
Unsporting Behavior (UB)
Persistent Infringement
Delaying Restart
Dissent
Leave/Enter Field Without Permission
Fails to Respect Required Distance
Stopping Promising Attack (SPA)
DOGSO (Attempting to Play Ball in Penalty Area)
Caution 3 Player/Coach Name
Caution 3 Team & Jersey #
Reason for Caution 3
Unsporting Behavior (UB)
Persistent Infringement
Delaying Restart
Dissent
Leave/Enter Field Without Permission
Fails to Respect Required Distance
Stopping Promising Attack (SPA)
DOGSO (Attempting to Play Ball in Penalty Area)
Caution 4 Player/Coach Name
Caution 4 Team & Jersey #
Reason for Caution 4
Unsporting Behavior (UB)
Persistent Infringement
Delaying Restart
Dissent
Leave/Enter Field Without Permission
Fails to Respect Required Distance
Stopping Promising Attack (SPA)
DOGSO (Attempting to Play Ball in Penalty Area)
Caution 5 Player/Coach Name
Caution 5 Team & Jersey #
Reason for Caution 5
Unsporting Behavior (UB)
Persistent Infringement
Delaying Restart
Dissent
Leave/Enter Field Without Permission
Fails to Respect Required Distance
Stopping Promising Attack (SPA)
DOGSO (Attempting to Play Ball in Penalty Area)
Caution 6 Player/Coach Name
Caution 6 Team & Jersey #
Reason for Caution 6
Unsporting Behavior (UB)
Persistent Infringement
Delaying Restart
Dissent
Leave/Enter Field Without Permission
Fails to Respect Required Distance
Stopping Promising Attack (SPA)
DOGSO (Attempting to Play Ball in Penalty Area)
Red Card/Send Off
Send Off 1 Player/Coach Name
Send Off 1 Team & Jersey #
Reason for Send Off 1
Second Caution
Serious Foul Play (SFP)
Spitting
Violent Conduct (VC)
Referee Assault
DOGSO Foul (No Attempt to Play the Ball)
DOGSO Handling
Offensive/Insulting/Abusive Language
Irresponsible Behavior (Coach or Bench)
Send Off 2 Player/Coach Name
Send Off 2 Team & Jersey #
Reason for Send Off 2
Second Caution
Serious Foul Play (SFP)
Spitting
Violent Conduct (VC)
Referee Assault
DOGSO Foul (No Attempt to Play the Ball)
DOGSO Handling
Offensive/Insulting/Abusive Language
Irresponsible Behavior (Coach or Bench)
Send Off 3 Player/Coach Name
Send Off 3 Team & Jersey #
Reason for Send Off 3
Second Caution
Serious Foul Play (SFP)
Spitting
Violent Conduct (VC)
Referee Assault
DOGSO Foul (No Attempt to Play the Ball)
DOGSO Handling
Offensive/Insulting/Abusive Language
Irresponsible Behavior (Coach or Bench)
Describe in detail any injuries, cautions, or send offs
*
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