Home Team ______________________________	Visiting Team __________________________
Date ____________________________________	Offender _____________________________
Offending School ___________________________	League ______________________________

(Circle One)	(Circle Sport)		(Circle One)	(Circle One)
Athlete	Volleyball	Boys Basketball	Violent Conduct	Varsity
Coach	Football	Girls Basketball	Serious Foul Play	Junior Varsity
Team	Girls Soccer	Wrestling	Foul/Abusive Language	Freshman/'C' Team
Fan	Boys Soccer	Gymnastics	Persistent Infringment	Middle School/J.H.
	Baseball	Softball	Enter/Leaving Field W/O Permission
			Unsportsmanlike Conduct
			Taunting

WIAA EJECTION/CONDUCT REPORT PROCEDURE	COMMENTS (Please be specific)
Please follow the below procedure for administering an ejection:	_______________________________________________________
During the contest	_______________________________________________________
Confer with your partner if applicable before administering the ejection.	_______________________________________________________
Notify the coach of the ejection and the reasons. (The coach must inform the official of intent to appeal and record with the official scorer prior to resuming play).	_______________________________________________________
Resume play as soon as possible.	_______________________________________________________
After the contest	_______________________________________________________
Call the assigning secretary immediately that day/night (Leave a message if necessary).	_______________________________________________________
Fill out this conduct report and mail or fax IMMEDIATELY to the assigning secretary.	_______________________________________________________
ASSIGNING SECRETARY (not officials) MUST mail or fax the conduct report to the WIAA office within 48 hours of the ejection.	_______________________________________________________

Coach notified referee of intent to appeal _________

Officials Signature: ______________________ Assigning Secretary Signature: ____________ ASSOCIATION/BOARD: _______________

If more space is needed to record comments, please attach or write on the reverse of this form.