::: EPRU :::

Match Report - EPRU High School Boys

If you cannot use this form please email your information directly to Greg Karabin
Please email webmaster with suggestions and comments.

This report must be submitted by both Home and Away teams within 24 hours of the match.

Personal Information

Your Name:

Your Email:

Your Phone:

Your Club:

Match Data

Date of Match (mm/dd/yy):

Home Team:
, Other:

versus Visitors:
, Other:

Who won?
, Other:

Scoring

Winning:

Losing:

Final Score:

Trys Scored:

Conversions Scored:

Penalty Goals Scored:

Drop Goals Scored:

Medical Information

Yes or No, Which of the following was available at the match?

Medical Kit:

Athletic Trainer:

EMT:

Was an Emergency Action Plan (EAP) provided to visiting team by home team?

Did EAP provide address and directions to nearest hospital?

Other Medical Personnel

Describe:

If any players were injured, please provide name and describe injury:

Referee Information

If any players were 'sent off' by the referee, please provide name:

Name of referee:

Comments about referee:

Protest

Was this match played under protest by your team?

If yes, please provide details:

* You must provide protest information in writing, within 72 hours, to the EPRU President, Secretary, and Divisional Play Chairperson.

Identify players from your's or your opponent's club you think might be candidates for the EPRU All-Star team.

Name:

Position:

Email Address:

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Name:

Position:

Email Address:

--------------------------- ------------------------------------------------------

Name:

Position:

Email Address:

Personal Information
Your Name:
Your Email:
Your Phone:
Your Club:
Match Data
Date of Match (mm/dd/yy):
Home Team:	, Other:
versus Visitors:	, Other:
Who won?	, Other:
	Scoring
	Winning:	Losing:
Final Score:
Trys Scored:
Conversions Scored:
Penalty Goals Scored:
Drop Goals Scored:
Medical Information
Yes or No, Which of the following was available at the match?
Medical Kit:
Athletic Trainer:
EMT:
Was an Emergency Action Plan (EAP) provided to visiting team by home team?
Did EAP provide address and directions to nearest hospital?
Other Medical Personnel
Describe:
If any players were injured, please provide name and describe injury:
Referee Information
If any players were 'sent off' by the referee, please provide name:
Name of referee:
Comments about referee:
Protest
Was this match played under protest by your team?
If yes, please provide details:	* You must provide protest information in writing, within 72 hours, to the EPRU President, Secretary, and Divisional Play Chairperson.
Identify players from your's or your opponent's club you think might be candidates for the EPRU All-Star team.
Name:
Position:
Email Address:
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Name:
Position:
Email Address:
---------------------------	------------------------------------------------------
Name:
Position:
Email Address: