Referee’s Report
Sin Bin
Club / Last Name CIPP #Send Off
Club / Last Name CIPP #Field Comments:
INSTRUCTIONS
COACH or CAPTAIN
1. Fill out this roster legibly. IMPORTANT: All names and CIPP numbers must be correct. Your players must be prepared to show current identification if requested.
2. A CLUB player can be circled “Y” (under Citizenship) if that individual has had their citizenship verified by USA Rugby or if they have been granted a waiver from the USA Rugby Eligibility Committee. In either case, that information must be posted on the USA Rugby CIPP database. A Collegiate player can be circled “Y” (under Eligibility) if that Students name is listed on the teams Collegiate Eligibility Form
3. Players not listed in the USA Rugby database as verified, must have legible copies of proof of citizenship in the clubs notebook before they can be listed with a “Y” next to their name. Players unable to provide such documentation will list as non-resident players. Collegiate players not listed on the clubs Collegiate Eligibility cannot be circled “Y”; and therefore must be circled “N”
4. In all CLUB SIDE matches reserve players are fixed at match time. No additions, substitutions, or replacements can made to the reserve player list after the match has begun. COLLEGIATE SIDES may draw from any player listed on the teams Collegiate Eligibility Form.
5. In both cases, two reserves must be identified as front row players. Please indicate these two in the reserves section by checking the (FR) box next to the appropriate name.
6. List Team Field Monitor (required by NCRFU Safety Protocol) at top of form.
REFEREE
1. Fill out this document legibly and completely. Teams are responsible for their own rosters.
2. Seal with tape or stable and mail immediately.
Match ReportHome Club: ______Visiting Club: ______
Field Monitor: ______Field Monitor: ______
Date: Name (please print clearly) CIPP # ResidentName (please print clearly) CIPP # Resident
1 # Y N1 # Y N
Location: 2 # Y N2 # Y N
3 # Y N3 # Y N
Time: 4 # Y N4 # Y N
5 # Y N5 # Y N
Referee: 6 # Y N6 # Y N
7 # Y N7 # Y N
Match Score:8 # Y N8 # Y N
1st Half Home - Visitor9 # Y N9 # Y N
Tries: - 10 # Y N10 # Y N
Conversions: - 11 # Y N11 # Y N
Penalty kicks: - 12 # Y N12 # Y N
Yellow cards: - 13 # Y N13 # Y N
Red Cards: - 14 # Y N14 # Y N
2nd Half Home - Visitor15 # Y N15 # Y N
Tries: - Reserves (Circle Front Row Reserves)Reserves (Circle Front Row Reserves)
Conversions: - 16 # Y N16 # Y N
Penalty kicks: - 17 # Y N17 # Y N
Yellow cards: - 18 # Y N18 # Y N
Red Cards: - 19 # Y N19 # Y N
20 # Y N20 # Y N
FINAL SCORE - 21 # Y N21 # Y N
22 # Y N22 # Y N
23 # Y N23 # Y N
Referee’s SignatureRepresentative SignatureRepresentative Signature
(X): (X):(X):