Competitive Match Report - Minnesota Youth Soccer Association
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1Competitive Match Report
District: ___________________ Date Played: ________ Master Game #: ______
WGU13C2
1/1/15
12345
Team Code: _______________ Goals Scored: _______ Field Code: __________
CCU13GC201
CCU07
Opponent: ________________ Goals Scored: _______ Total Time Played: ____
MNK13GC202
check BEFORE match if playing under protest, describe protest on back.
COACH Section
REFEREE Section
Failure to submit a completed line-up prior to the start of the match will
Complete and mail within 48 hours of match to:
result in a forfeit.
MYSA, 11577 Encore Circle, Minnetonka, MN 55343
Rostered Players
Use back to describe protests, cards, injuries or incidents.
Pre-Match Checklist
Player’s Name
Registration
Jersey
Caution Send-Off
Match may not start until complete.
1
Mary Johnson
123456
1
Field Safety
goals anchored
2
Jane Smith
234566
2
field surface safe
Participant Check-In
3
check each participant with valid pass
4
all passes from same club
all passes for current season
5
passes signed/picture/laminated
adult with pass present
6
confiscate and attach illegal passes
7
NO PASS / NO PLAY / NO EXCEPTION
8
Record Cautions/Send-Offs
Note at left using codes below, confiscate
9
and attach ejected participant passes.
10
Caution Codes
c1
Unsporting Behavior
11
c2
Dissent
c3
Persistent Infringement
12
c4
Delaying a Restart of Play
maximum players...u9-10
c5
Fails to Respect Required Distance
c6
Illegally Enters Field of Play
13
c7
Illegally Leaves Field of Play
Send-Off Codes
14
e1
Serious Foul Play
maximum players...u11-12
e2
Violent Conduct
e3
Spitting At
15
e4
Denying OGSO - Handling
e5
Denying OGSO - Foul
16
e6
Insulting or Abusive Language
17
e7
Second Caution
Adult Dismissal Code
18
d1
Irresponsible Behavior
maximum players...u13-19
Play-Up(s)
• up to 3 play-ups from the same club per game, not to exceed roster max.
OATHS Evaluation
• play-ups must be from a younger age-level, or lower competitive division at the same age
Evaluate this team’s sportsmanship.
• Premier players may not play on Classic teams
5 = strongly agree, 1 = strongly disagree
Player’s Name
Registration
Jersey
Caution Send-Off
FANS
5
4
3
2
1
1
Enter Sub names here
345555
10
created a positive climate for everyone
COACHES
5
4
3
2
1
2
treat all players/officials with care and concern
3
PLAYERS
5
4
3
2
1
play within the rules and spirit of the game
Adult(s)
• at least one adult with a valid pass from the club must be present during the entire match
Adult’s Name
Registration
Warn
Dismiss
Match Official Information
1
Coach Name
1233
Referee: _______________________
Signature: ______________________
2
Manager Name
1233
Grade: ___ Phone: ______________
I certify all participants listed are eligible to participate in this match.
AR #1: ________________________
I understand listing an ineligible participant may result in sanctions.
AR #2: ________________________
Adult Signature: _____________________________________________
(required)
revised 1.18.10
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