CLUBS - Match Return Form

This Form should be completed and submitted within FOUR days of your match.

YOUR DETAILS

Your Name*

(First and Last Name)

Your Email Address*

Your Role*

Please list your role within the club

Club Name*

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MATCH DETAILS

Competition Name*

Select

Round*

Select

Match Date*

Home Team Name*

Away Team Name*

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SCORE

Home - Away

Full-Time*

Extra-Time

(only enter if required)

Penalty Shoot-out

(only enter if required)

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SQUAD - Starting Line-up

Player details

Shirt Number*

Select

Full Name*

(First and Last Name)

Shirt Number*

Select

Full Name*

(First and Last Name)

Shirt Number*

Select

Full Name*

(First and Last Name)

Shirt Number*

Select

Full Name*

(First and Last Name)

Shirt Number*

Select

Full Name*

(First and Last Name)

Shirt Number*

Select

Full Name*

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

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SQUAD - Substitutes

Player details (if played)

Shirt Number

Select

Full Name

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

Shirt Number

Select

Full Name

(First and Last Name)

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REFEREE

Name of Referee*

(First and Last Name)

REFEREE MARKS: To assist you when marking the Referee a 'Guide to Marking - Considerations' can be found attached below. The marks awarded by a club must be based on the Referee’s OVERALL performance. It is most important that the marks are awarded fairly and not based upon isolated incidents or previous games. The Referee’s overall performance and TOTAL MARK will be determined by the marks accumulated from each of the three standards of performance below. Our club awards the following marks:

Overall Decision Making*

Scale: 1 = Poor | 40 = Excellent

Select

Judgement of Major Decisions*

Scale: 1 = Poor | 30 = Excellent

Select

Overall Control and Player Management*

Scale: 1 = Poor | 30 = Excellent

Select

TOTAL MARK*

Add up the marks awarded above for the three standards of performance to give you the TOTAL MARK for the Referee's overall performance.

Select

Mark of 60 or less

When awarding a TOTAL MARK of 60 or less, an explanation must be provided in the box below with comments which could help the referee improve future performances.

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Declaration

I declare the information supplied is a true record of the match.*

Send me a copy of my responses

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