GEORGIA HIGH SCHOOL ASSOCIATION

PO BOX 271

THOMASTON, Georgia 30286-0004

706-647-7473 / FAX 706- 647-2638

GAME REPORT

Officials Association: Peach State Basketball Officials Association

Game: Visiting Team: vs. Home Team:

Site (City): Date:

Sport: Basketball - Boys ( )

Basketball - Girls ( )

Type of Report: ( ) Disqualification/Ejection ( ) Technical Foul ( ) Forfeited Game

( ) Serious Injury ( ) Other

( ) Court Conditions

Player or Coach Committing Violation Number Team Rule Violation Infraction

Example: John Doe #30 GHSA H.S. Taunting (Soccer Rule 12-8-2a)

Check when incident occurred

1^st Qtr ( ) 2^nd Qtr ( ) 3^rd Qtr ( ) 4^th Qtr ( ) Before Game ( ) After Game ( ) Half-time ( )

Give brief factual narratives of violation without any editorial comments:

Official Making Report: Date:

Date forwarded to GHSA:

Signed: Esther Ray - PSBOA Secretary