| This form will allow you to report up to 2 infractions for 1 individual.
If there are more codes or individuals, submit the information on a new form.
REPORTED BY: |
| Your Name: (*) |
Please type your full name. |
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| E-Mail: (*) |
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| Phone Number: (*) |
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TEAM INFORMATION: |
| Association: (*) |
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| Division: (*) |
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| Level: (*) |
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| Team: (*) |
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PLAYER or TEAM OFFICIAL being REPORTED:
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| Name: |
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| Player Number: |
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| Team Position: (*) |
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INFRACTION: General
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| Game Date: (*) |
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INFRACTION: Incident 1
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| Period: (*) |
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| Time (stop clock): (*) |
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| Infraction: (*) |
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| Comment: |
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INFRACTION: Incident 2
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| Period: |
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| Time: |
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| Infraction: |
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| Comment: |
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DISCIPLINE:
Based on the disciplinary actions outlined in the ODMHA Code of Discipline, outline the discipline to be applied to this situation. NOTE: for fighting infractions refer to LCMHL regulations for additional penalties.
Remember to take into consideration if this player / team official has had previous occurances of the same infraction / game misconduct.
All disciplinary actions will be verified by the LCMHL President or Vice President.
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| First occurence this season? |
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| Number of games to serve: |
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| Comment: |
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| Game dates - suspension to be served: |
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FAX the game sheet to 888-313-0883.
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