Date:       Game Number:  

Gender:  - choices - mixed boys girls    Age Group:  -Choose from below- U-8 U-9 U-10 U-11 U-12 U-13 U-14 U-15 U-16 U-17 U-18 U-19      Division:  1 2 3

Field Location: 

Scheduled Time of Kick-off:    
Actual Time of Kick-off: 

Home Team: 

Home Score: 

Home Team Cautions (include jersey number, player name, player i.d.# and offense for each):
              

Home Team Ejections (include jersey number, player name, player i.d. # and offense for each)...passes of those ejected must be sent into the league office
              

Visitor Team: 

Visitor Score: 

Visitor Team Cautions (include jersey number, player name, player i.d. # and offense for each):
              

Visitor Team Ejections (include jersey number, player name, player i.d. # and offense for each)...passes of those ejected must be sent into the league office
              

The match was decided in (select one):

Regulation Time
A Team Did Not Show
Game Called w/ more than ½ Time Played or Action of Team (Explain below in Supplementary Report) 
Game Called w/ less than ½ Time Played or Stopped While Score Tied (Explain below in Supplementary Report) 

Supplementary Report/Comments/Incidents:
             

Fees Paid?   Yes      No

Referee: 

Sr. Assistant (bench line): 

Jr. Assistant (spectator line): 

Email address: