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Please use this form to provide timely feedback on our referees and on anything else you may have observed at a game. If you believe that there is a problem, then we'd like to address that as quickly as possible. If you believe that a referee has done a good job, we'd like to know that and we'd like them to know it as well. Please remember that many of our referees are young and still learning. Your constructive feedback, your support and patience at the field and your praise, where appropriate, will help them to do a difficult job and continue to develop their skills.

This form is primarily intended for reports on referees and games in the Youth House Leagues (Indoor or Outdoor). You may submit a report on a game in another division and we will do our best to address that as well.

Fields with a red asterisk are mandatory.

	Referee and Game Feedback Form
	Please use this form to provide timely feedback on our referees and on anything else you may have observed at a game. If you believe that there is a problem, then we'd like to address that as quickly as possible. If you believe that a referee has done a good job, we'd like to know that and we'd like them to know it as well. Please remember that many of our referees are young and still learning. Your constructive feedback, your support and patience at the field and your praise, where appropriate, will help them to do a difficult job and continue to develop their skills. This form is primarily intended for reports on referees and games in the Youth House Leagues (Indoor or Outdoor). You may submit a report on a game in another division and we will do our best to address that as well. Fields with a red asterisk are mandatory.
	Game Information
	Game Date (dd mm yy)*:
	Game Time*:
	Field*:
	First Team (color +/or sponsor):
	Second Team (color +/or sponsor):
	Age Division*:
	Gender of the Players*:	MaleFemaleMixed
	Program*:	Youth House LeagueOther (specify below)
	General Referee Feedback
	Was the referee on-time?:
	Was the referee dressed appropriately?:
	Did the referee move with the play?:
	Did the referee take charge of the game?:
	Did the referee seem confident when making calls?:
	Was the referee clear in directions given to players and coaches?:
	Did the referee appear to monitor / enforce equal play (House League)?:
	Specific Feedback
	Did the referee miss or incorrectly make any calls that had a serious negative impact on the game?:
	Did the referee appear to have a good relationship with the players, coaches and spectators?:
	Were there any incidents in the game involving the referee, players, coaches or spectators that you would like to report?:
	Any other comments?:
	Contact Information and About You
	You may provide anonymous feedback; however, we would prefer that you provide us with the information below. This provides a context for your comments. We may also need additional clarification of your feedback.
	Your First Name:
	Your Last Name:
	Phone Number:
	Email Address:
	Were you a coach of one of these teams (if so, which one)?:
	Were you a parent of a player on one of these teams (and if so, which one)?:
	Which team won the game?:
	Have you had any formal training yourself as a coach or as a referee (please provide info on what levels you have completed)?:
	Do you wish to discuss this further with someone from the Club?:	YesNo
	Closing
	Thank you for taking the time to provide us with this feedback. This helps us to be more aware of what is happening on the field and to address any issues in a timely manner. Privacy We respect your privacy and appreciate that this feedback is given in confidence. Access to this form within the Club will be limited to those who need to know. We will not share any identifying information from this form with players, coaches, convenors or referees without your permission. We may use your specific description of events if this does not compromise your privacy. If you have completed the form, then please click the Submit Form button below.