PRELIMINARY DISCIPLINARY FORM
[For Schools or Club Youth Player Only]
MATCH _______________________ v______________________ DATE____________
I, being the appointed Referee to the above rugby match, have Sent Off:
NAME of PLAYER ________________________________
TEAM _____________________________ NUMBER or POSITION ______________
For the following offence [Tick the offence and circle if there is an alternate]
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OFFENCE
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Repeated infringements
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Dissent
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Abusive behaviour to other players
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Collapse ruck or maul
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Collapse scrum
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Dangerous tackle
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Obstruction or late tackle
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Hit, punch or trip an opponent
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Dangerous use of boot or kneeing
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*Wilfully kick an opponent
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*Bite an opponent
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*Head butt an opponent
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*Abusive behaviour to an official
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*Assault an official
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*These are serious offences My report will follow.
NAME of REFEREE _____________________________ SOCIETY _________________
Signed ____________________________