Rapport District Pour Imprimer

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RAPPORT D’ARBITRAGE Expéditeur :

M. ...............................................................................

N° de Licence : ........................................................

A retourner à : District Côte d'Opale de Football. 50, rue Sydney Brown. B.P. n°7. 62340 GUINES (sauf compétitions Ligue, envoi à la Ligue)

Date : .................................. Heure : .... H .... N° de match : ...................... Terrain : ............................................................. Championnat Division : ...................................... Groupe : ............ Seniors Jeunes (Catégorie) : ............... Coupe : ........................................... Autre (préciser) : .................................................... Féminines Lettres

Chiffres

Tirs au but

EQUIPES EN PRESENCE RAPPORT DETAILLE AU VERSO

Arbitre : M …………………………………………………………….. Assistant n° 1 : M …………………………………………………… Assistant n° 2 : M …………………………………………………… Délégué Ter. : M ……………………….. N° Lic. : …………………

Exclusions

Non joué

Match arrêté

Réserve technique

Réserve Adm.

Saisie de Licence

RAPPORT concernant JOUEURS AVERTIS ou EXPULSES / AUTRES PERSONNES N°

Avt 1

Avt 2

Exc

NOM Prénom du joueur

Mn

Motif

….

M....................................................... N° Lic. : ...........................................

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M....................................................... N° Lic. : ...........................................

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M....................................................... N° Lic. : ...........................................

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M....................................................... N° Lic. : ...........................................

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……………………………………………………………. …………………………………………………………….

Autres Personnes

Fonction

N° Licence

Minute et Motif (rapport au dos)

M…………………………………. Club : ……………………………. …………………….

………………. ….. ’ ..............................................................................

M…………………………………. Club : ……………………………. …………………….

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M…………………………………. Club : ……………………………. …………………….

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Saisie de licence. Transmission (District / Ligue / FFF ===> en fonction du niveau de la compétition) Transmission de(s) la licence(s) ou de la pièce d’identité non officielle M. ……………………………………… Club : …………………………….. M. ……………………………………… Club : …………………………….. M. ……………………………………… Club : ……………………………..

du (des) joueur(s) Motif : ....................................................................... Motif : ....................................................................... Motif : .......................................................................

DISCIPLINE – RAPPORT COMPLEMENTAIRE (concernant les exclusions de joueurs, remplaçants, remplacés ainsi que toute autre personne) ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………………………………..

Rapport complémentaire concernant d’éventuels incidents avant, pendant ou après le match ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………………………………..

Observations diverses (saisie de licence ou pièce non officielle, terrain, installations, etc…) ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………………………………..

Rapport rédigé le : ………………………………….

Signature

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