DUKE CITY SOCCER LEAGUE REFEREE ABUSE REPORT

This report may be submitted by any person for observation of referees being mistreated or abused by any participant of a match. This may include but is not limited to players, coaches, directors of coaching, other club representatives, spectators, and parents.

Reporting Party Name *

First

Last

Reporting Party Email *

Reporting Party Phone Number

Reporting Party Role

Date / Time of Match

Date

Time

Field Location of Match

Home Team

Away Team

Person(s) mistreating or abusing referee(s)

Which team is the person(s) being reported associated with? *

Is the person(s) mistreating or abusing referees an adult, or appear to be an adult?

Is the referee(s) being mistreated or abused a minor (under 18), or appear to be a minor?

Please Provide Link to video if available

Please upload video if available

Click or drag a file to this area to upload.

Did the abuse include verbal abuse?

REPORT NARRATIVE

REPORT NARRATIVE INSTRUCTIONS In the space below, please provide a BRIEF but detailed description of the incident . BE BRIEF BUT AS SPECIFIC AS POSSIBLE. Enter exact words or phrases spoken, including profanity. Enter exact actions or gestures, if applicable. Enter exact physical contact, if applicable. Provide all FACTS that are applicable. Details of referee decision and/or its accuracy are not required. Please avoid commentary, background information, or opinion.

Were you on the referee crew for this game?