RUGBY INDIANA
MATCH REPORT
Date:
Location:
Home Club:
Visiting Club:
Referee:
Society:
Pitch Conditions
Goal Posts/Pads Yes No
Pitch Markings Good Fair Poor
Pitch Barriers Yes No
Pitch Size Max Narrow Short
Home Club
Numbered Jerseys Yes No
Uniform Condition Good Fair
Poor
Visiting Club
Numbered Jerseys Yes No
Uniform Condition Good Fair Poor
Disciplinary Action
Players 'Sin-Binned' Yes No
Players Sent-Off Yes No
Club Jersey # Name CIPP #
Offense
Score 1st Half 2nd Half Total Tries
Home
Visitor
Referee’s Signature CIPP#
Home Club
# / Last Name / CIPP #1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Reserves
16
17
18
19
20
21
Club Official Signature CIPP#
Print Name
By signing above, the club official attests that the above players have proper individual insurance and that the players and club have USA Rugby CIPP liability coverage.
Visiting Club
# / Last Name / CIPP #1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Reserves
16
17
18
19
20
21
Club Official Signature CIPP#
Print Name
By signing above, the club official attests that the above players have proper individual insurance and that the players and club have USA Rugby CIPP liability coverage.
Rugby Indiana Match Report
This report form is to provide an official record of the match for Rugby Indiana and the Indiana Rugby Referee Society. It is the home club’s responsibility to turn the completed form (both home and visiting sides rosters listed) over to the referee before kick-off.
Requirements:
Home Club
1. Complete the Home Club section of the form in full and have it signed by the club’s official.
2. Give the form to the Visiting Club and have them complete the Visiting Club section of the form in full and have it signed by the club’s official.
3. Officials from both clubs verify CIPP enrollment for all participating players.
*This year it will be acceptable to print a copy of your roster from usarugby.org, number your players (1-15) and alternates (16-23), and attach to back of this report.
Referee
1. Complete the Referee section of the form and Additional Comments.
2. Keep a copy for your records
3. Forward the completed form to the IYRF Executive Director via US Postal Service or e-mail , and when possible scan and upload document to: http://public.me.com/craftt
CIPP
All Rugby Indiana registered clubs are required to be enrolled in the USA Rugby Club and Individual Participation Program (CIPP).
Insurance
USA Rugby and Rugby Indiana requires that all players have medial insurance coverage of at least $100,000. “Any player without this level of coverage is not eligible to participate in any Rugby Indiana or USA Rugby sanctioned match."
Additional Comments:
Match Play
Pitch Conditions
Other