Section V . . . Athletic Association
Disqualification Form
Date of Event: ___________________________ Sport: _________________________
Level of Competition: (circle one) Freshman Junior Varsity Varsity
Home School: _______________________ Opponent: __________________________
Name of Disqualified Player/Coach …………………………………………………….
Official(s) Assigned – please print: …………………………………………………….
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Reason for Disqualification: Flagrant Misconduct (physical) _____________________
Flagrant Misconduct (verbal/dissent/taunting) __________
Other __________________________________________
Description:…………………………………………………………………………………………………
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Signature of Official issuing Disqualification: …………………………………………….
Date: …………………………………………..
NOTE:
The home school Athletic Director MUST be notified by the Official issuing the disqualification within twenty-four (24) hours or by the end of the next school day.
The Official issuing the disqualification MUST file this report with three (3) days to.
The school of the disqualified player.
The league coordinator or designee.
The President of the Referees Unit
Section V Executive Director …
Mr. Ed Stores
5151 Kelly Rd.
Wyoming, NY
14591-9745
It is the responsibility of the school to have a copy of this form available at all home athletic contests.