| 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. |