First Name:

Last Name:

Title:

Organization:

Select Town Berlin Bristol Central Valley East Hartford Hartford Meriden New Britain Newington Simsbury/Avon Tri-Town Torrington Wallingford Waterbury Water-Oak Wolcott

Home Phone:

Email:

Team Division:

Select Division Midget Jr. Midget Peewee Jr. Peewee Mitey Mites Senior Mites

Opposing Team:

Select Town Berlin Bristol Central Valley East Hartford Hartford Meriden New Britain Newington Simsbury/Avon Tri-Town Torrington Wallingford Waterbury Water-Oak Wolcott

Game Week:

Select Week Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10

Location of Game:

Select Town Berlin Bristol Central Valley East Hartford Hartford Meriden New Britain Newington Simsbury/Avon Tri-Town Torrington Wallingford Waterbury Water-Oak Wolcott

Field Condition:

Select Condition Excellent Good Fair Poor

Field Description:

Select Description Dry-good footing Wet-footing OK Wet-slippery Muddy-with puddles Hard Surface-very cold

Official's Name 1:

Rating for #1:

Select Rating Excellent Very Good Good Fair Poor

Official's Name 2:

Rating for #2:

Select Rating Excellent Very Good Good Fair Poor

Official's Name 3:

Rating for #3:

Select Rating Excellent Very Good Good Fair Poor

1. Were ALL the officials knowledgeable of the game rules?

Select Reply Yes No Not all

2. Did the Officials handle the game appropriately with common sense?

Select Reply Yes No

3. Did the Officials respond well under pressure?

Select Reply Yes No

4. Did Officials keep players and coaches under control?

Select Reply Yes No

5. Did the correct number of Officials work at the game?

Select Reply Yes No

6. Did the opposing coach, team, or crowd become unruly?

Select Reply No Coach Team Crowd All of the above

Please add any additional details/feedback in the box below: