Abuse |
Assault |
| Game: |
Home Team:
|
Score:
(enter "Zero" for "0")
|
Visiting
Team:
|
Score:
(enter "Zero" for "0")
|
State Assocation:
Indiana Youth Soccer |
Division:
|
Age Group:
|
Field and Address:
|
Date
of Game:
|
Scheduled Time:
Actual Kickoff:
|
Referee:
|
Grade:
|
Phone:
|
Assistant:
|
Grade:
|
Phone:
|
Assistant:
|
Grade:
|
Phone:
|
| The United
States Soccer Federation Rule 531-9 ¶(3) §(a)
(i) states; “Referee assault is an intentional
act of physical violence at or upon a referee.
(ii) For purposes of this policy, “intentional
act” shall mean an act intended to bring
about a result, which will invade the interest
of another in a way that is socially unacceptable.
Unintended consequences of the act are irrelevant.
(b) Assault includes, but is not limited to the
following acts committed upon a referee: hitting,
kicking, punching, choking, spitting on, grabbing
or bodily running into a referee; head butting;
the act of kicking or throwing any object at a
referee that could inflict injury; damaging the
referee’s uniform or personal property, i.e.
car, equipment, etc. Rule 531-9 ¶(4) §(a)
also states;
“Referee abuse is a verbal statement or physical
act not resulting in bodily contact which implies
or threatens physical harm to a referee or the
referee’s property or equipment.” |
The
abuse/assault was committed by:
Coach
Player
Parent |
The
coach/player/parent is with:
Home Team
Away Team |
| Witnesses: |
Witness
1:
|
Work Phone:
|
Home Phone:
|
Witness
2:
|
Work Phone:
|
Home Phone:
|
Witness
3:
|
Work Phone:
|
Home Phone:
|
Describe
the details of the abuse/assault below. Please
be very specific.
|
|
I hereby believe all information submitted above
to be correct and true. |
Referee
Submitting Form:
|
Phone:
|
