| Type of Incident: | Other — Do not use if a team, player, coach, or spectator is involved.  Use only if the incident cannot be classified as any other Type of Incident above. | 
| Date of Incident: | 2023-10-21 | 
| Time of Incident: | 16:30:00 | 
| Location of Incident: | Marlin Park Soccer Field | 
| Home Team: | JRS 2011 | 
| Visiting Team: | SVE 11-12G | 
| Age Group and Gender: | U13G | 
| Team Affiliation of Individual Committing Incident: | JRS 2011 | 
| Incident Summary: | Report of racist epithet being directed at a player in a match.  | 
| Comments: | The PAD Committee does not review reports filed by Team Coaches.  Please contact your club leadership if you wish to have this refiled.  |