True South Union Match Day Roster/Score/Sub Form Your Team

POS NAME

Opponent

CIPP #

Location

F. ROW CAPABLE

SUB -ON/OFF REASON / TIME

Date

Time

SCORE TYPE/TIME Opponent Scoring

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 R-16 R-17 R-18 R-19 R-20 R-21 R-22 R-23 SCORE TYPES: T=Try(5 pts);PT=Penalty Try(5 pts);C=Conversion(2 pts);PK=Penalty Kick(3 pts);DG=Drop Goal(3 pts) SUB CODES: (RI)Replacement Injury, (ST)Substitution Tactical, (TRB) Blood and/or Open Wound, (BPR) Player returns after blood, (SIN) Sin Bin, (SBR) Player Returns, (SO) Send Off, (SBALT) Player off for a front row player during Sin Bin, (SBALTR) Player Returns after front row Sin Bin Captains' Acknowledment- As captain, I hereby affirm that this represents the complete record ofplayers in the match described above, that are all compliant with USA rugby elegibility rules and are members in good standing with USA Rugby (CIPP). It is your responsibilty to verify the accuracy on this form.

Captain: Opposing Captain:

Signature: Signature:

Date: Date: YES

TO BE COMPLETED BY REFEREE:

Final Score: Home: Tries Scored: Home: Game Played Under Protest? NOTES: Referee:

Away: Away: Yes

No Signature:

Field Properly Marked Goal Post Padding Restraining Barrier Date:

NO