SAN GABRIEL VALLEY SOCCER OFFICIALS ASSOCIATION

DISQUALIFICATION / INCIDENT / INJURY REPORT

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DATE: (MM-DD-YYYY) TIME: FIELD:

DIVISION: VARSITY JR. VARSITY F/S              BOYS GIRLS

REFEREE: &

A1-GUILTY OF UNSPORTING BEHAVIOR; A2-SHOWS DISSENT BY WORK OR ACTION; A3-PERSISTENTLY INFRINGES THE LAWS OF THE GAME; A4-DELAYS THE RESTART OF PLAY; A5-FAILS TO RESPECT THE REQUIRED DISTANCE WHEN PLAY IS RESTARTED WITH A CORNER KICK OR FREE KICK; A6-ENTERS OR RE-ENTERS THE FIELD OF PLAY WITHOUT THE REFEREE’S PERMISSION; A7-DELIBERATELY LEAVES THE FIELD OF PLAY WITHOUT THE REFEREE’S PERMISSION

CAUTION - AMONESTADOS

D1-GUILTY OF SERIOUS FOUL PLAY; D2-GUILTY OF VIOLENT CONDUCT; D3-SPITS AT AN OPPONENT OR ANY OTHER PERSON D4-DENIES THE OPPOSING TEAM A GOAL OR AN OBVIOUS GOAL SCORING OPPORTUNITY BY DELIBERATLY HANDLING THE BAL (THIS DOES NOT APPLY TO A GOALKEEPER WITHIN HIS OWN PENALTY AREA); D5-DENIES AN OBVIOUS GOAL SCORING OPPORTUNITY TO AN OPPONENT MOVING TOWARDS THE PLAYER’S GOAL BY AN OFFENSE PUNNISHABLE BY A FREE KICK OR A PENALTY KICK; D6-USES OFFENSIVE OR INSULTING OR ABUSIVE LANGUAGE AND / OR GESTURES; D7-RECEIVES A SECOND CAUTION IN THE SAME MATCH; D8-TAUNTING

DISQUALIFICATION - EXPULSADOS

REMARKS – COMENTARIOS – ADICIONALES

HAD THE DISQUALIFIED PERSON BEEN CAUTIONED BEFORE IN THIS GAME? YES NO

SR REFEREE – NAME PHONE SAN GABRIEL VALLEY CHAPTER

WITHIN 12 HOURS OF THIS INCIDENT, YOU MUST FAX A COPY OF THIS REPORT TO TONY VASQUEZ 3724 SHEFFIELD AVE, LA, CA 90032 PHONE / FAX 323-221-3090, E-MAIL AVASQ23996@AOL.COM