Administrator: David C. Lowe 1 Moorfield Road Dentons Green St. Helens WA10 6AU
Official notification of a Brawl having occurred during the Gillette Conference Youth League
match featuring the club teams named below:
Home Team: Away Team:
Date of Match: Venue:
Time of Brawl: Score at Brawl:
Weather: Pitch Condition:
Full Name Shirt Team
Number
Instigator
Retaliator
Please place a () in the box which you consider to be most appropriate
Number of players involved Less than 2 3 or 4 5 or 6 7 or more
Number of players “punching” Less than 2 3 or 4 5 or 6 7 or more
Number of players “running in” Less than 2 3 or 4 5 or 6 7 or more
Number of club officials None 1 2 3 or more
involved
Number of Spectators Involved None 1 2 3 or more
Brawl Duration Up to-20 20-40 40-60 Over 60
Seconds Seconds Seconds Seconds
Please note below injuries caused as a direct consequence of the brawl
Was the match If Yes, by which club
recorded?
Medical aid required? If Yes, was it local or external
A full description of the brawl is as follows
Details of a previous caution administered to any player involved in the brawl
Referee’s distance from incident: Possibility of mistaken identity of any person
named in this report:
Referee’s Name & Society: Referee’s Signature:
This form when duly completed and signed by the referee to be forwarded by email for receipt inside
three working days of the game’s conclusion to: David C. Lowe.
Copies of this report must be released to and lodged with the offending clubs concerned for receipt
within FIVE working days of the game’s conclusion.