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PLEASE SEND PLAYER CARD(S) TO THE ADDRESS BELOW AS SOON AS POSSIBLE

Type or print legibly. Reports must be EMAILED within 48 hours of game. Be concise and specific. Each offense requires a separate report. N.T.C.S.A. REFEREE’S REPORT OF MISCONDUCT TO: NORTH TEXAS CO-ED SOCCER ASSOCIATION Phone: (469) 330-0778 P.O. BOX 831297 Fax: (214) 440-2073 RICHARDSON, TX 75083-1297 Email: [email protected] FROM: ______REFEREE Report Date:______Phone: ( )_____-______CITY ______ZIP______

PLAYER: GAME GAME Cautioned or DATE ______FIELD ______TIME ______Sent off AGE GROUP ______DIVISION ______LEAGUE ______COACH Misconduct TEAM ______SCORE ______vs ______SCORE______Dismissed FIELD SPECTATOR CONDITIONS ______WEATHER ______Serious ASSISTANT Misconduct REFEREES: ______& ______

Offender ______No.______of Team ______Time of Incident: 1st half ______2nd half ______Other ______

CAUTION Unsporting Behavior SENT OFF Serious foul play FOR: FOR: Dissent Violent conduct

Persistent Infringement Spits at opponent/person

Delays restart Denies goal by handling ball

Fails to respect req. distance Denies goal scoring opportunity

Enter / re-enters field w/o Offensive, Insulting or Abusive permission language

Deliberately leaves field w/o Receives second caution permission

DETAILS OF THE OFFENSE ARE AS FOLLOWS:______Second caution must be on additional form, which the captain has. THANKS (Referee’s Signature)

------FOR LEAGUE USE ONLY ------

Caution Points: ______Players total points to date:______

Player was suspended from: ______Till: ______Hearing: ______