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  <content>
    
      
      
<div class="pageElement textBlockElement">
			<h3 style="text-align: left;">For Coaches Only</h3>
				
		<div class="text">
		<p>If you are a coach that has recently played a game in District 4, please feel free to fill out the form below with your referee evaluation. Please be specific with referee names and with all comments. Please be aware, you may be contacted to elaborate on your comments as we strive to provide the highest quality officiating.</p>
		</div>
	
  <span class="clearAll"></span>     
</div>

    
      
      
<div class="pageElement textBlockElement">
				
		<div class="text">
		<form action="/custom_form/send_email" method="post">	

	<input type="hidden" value="Minnesota Hockey District 4 Referee Review" name="subject" />        
    <input type="hidden" value="rss10@hotmail.com" name="email" />        
    <input type="hidden" value="25008" name="page_id" />

	<div class="inputForm">
		<h3>Game Information</h3>
		<table>
			<tr>
				<th><label for="results[0:game_number]">Game Number:</label></th>
				<td><input class="small" id="results[0:game_number]" name="results[0:game_number]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[1:game_date]">Game Date:</label></th>
				<td><input class="medium" id="results[1:game_date]" name="results[1:game_date]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[2:game_level]">Game Level:</label></th>
				<td>
					<select id="results[2:game_level]" name="results[2:game_level]">
						<option value="No Level Selected">SELECT</option>
						<option value="Bantam A">Bantam A</option>
						<option value="Bantam B">Bantam B</option>
						<option value="PeeWee A">PeeWee A</option>
						<option value="PeeWee B">PeeWee B</option>
						<option value="Squirt A">Squirt A</option>
						<option value="Squirt B">Squirt B</option>
						<option value="Girls U14">Girls U14</option>
						<option value="Girls U12">Girls U12</option>
					</select>	
				</td>
			</tr>
			<tr>
				<th><label for="results[3:game_type]">Game Type:</label></th>
				<td>
					<select id="results[3:game_type]" name="results[3:game_type]">
						<option value="No Game Type Selected">SELECT</option>
						<option value="League">League</option>
						<option value="Playoff">Playoff</option>
						<option value="Scrimmage">Scrimmage</option>
						<option value="Tournament">Tournament</option>
						<option value="Tryout">Tryout</option>
					</select>	
				</td>
			</tr>
			<tr>
				<th><label for="results[4:home_team]">Home Team:</label></th>
				<td><input class="large" id="results[4:home_team]" name="results[4:home_team]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[5:visiting_team]">Visiting Team:</label></th>
				<td><input class="large" id="results[5:visiting_team]" name="results[5:visiting_team]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[6:arena]">Arena:</label></th>
				<td><input class="large" id="results[6:arena]" name="results[6:arena]" type="text" /></td>
			</tr>
		</table>
	</div>
    <br />      
	<div class="inputForm">
		<h3>Officials Information</h3>
		<table>
			<tr>
				<th><label for="results[7:official_1]">Official 1 Name or Number:</label></th>
				<td><input class="large" id="results[7:official_1]" name="results[7:official_1]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[8:official_2]">Official 2 Name or Number:</label></th>
				<td><input class="large" id="results[8:official_2]" name="results[8:official_2]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[9:official_3]">Official 3 Name or Number:</label></th>
				<td><input class="large" id="results[9:official_3]" name="results[9:official_3]" type="text" /></td>
			</tr>
			
			<tr>
				<th><label for="results[10:officials_professional]">Did the Officials conduct themselves in a professional manner?:</label></th>
				<td>
					<select id="results[10:officials_professional]" name="results[10:officials_professional]">
						<option value="Yes">Yes</option>
						<option value="No">No</option>
					</select>	
				</td>
			</tr>
			<tr>
				<th><label for="results[11:officials_communicate]">Did the Officials communicate effectively with the players?</label></th>
				<td>
					<select id="results[11:officials_communicate]" name="results[11:officials_communicate]">
						<option value="Yes">Yes</option>
						<option value="No">No</option>
					</select>	
				</td>
			</tr>
			<tr>
				<th><label for="results[12:officials_hustle]">Did the Officials hustle?</label></th>
				<td>
					<select id="results[12:officials_hustle]" name="results[12:officials_hustle]">
						<option value="Yes">Yes</option>
						<option value="No">No</option>
					</select>	
				</td>
			</tr>
			<tr>
				<th><label for="results[13:officials_in_position]">Were the Officials in position to make the calls?</label></th>
				<td>
					<select id="results[13:officials_in_position]" name="results[13:officials_in_position]">
						<option value="Yes">Yes</option>
						<option value="No">No</option>
					</select>	
				</td>
			</tr>
			<tr>
				<th><label for="results[14:officials_knowledge]">Rate the rule knowledge of the Officials:</label></th>
				<td>
					<select id="results[14:officials_knowledge]" name="results[14:officials_knowledge]">
						<option value="No Rating Selected">SELECT</option>
						<option value="High">High</option>
						<option value="Average">Average</option>
						<option value="Low">Low</option>
					</select>	
				</td>
			</tr>
		</table>	
	</div>
    <br />
	<div class="inputForm">
		<h3>Your Information</h3>
		<table>
			<tr>
				<th><label for="results[15:name]">Your Name:</label></th>
				<td><input class="medium" id="results[15:name]" name="results[15:name]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[16:email]">Your Email Address:</label></th>
				<td><input class="large" id="results[16:email]" name="results[16:email]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[17:phone]">Your Phone Number:</label></th>
				<td><input class="medium" id="results[17:phone]" name="results[17:phone]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[18:team]">Your Team:</label></th>
				<td><input class="medium" id="results[18:team]" name="results[18:team]" type="text" /></td>
			</tr>
			<tr>
				<th><label for="results[19:comments]">Comments:</label></th>
				<td><textarea class="large" name="results[19:comments]"></textarea></td>
			</tr>
		</table>	
	</div>
	<div class="submitButton"><input type="submit" value="Submit Referee Review Form" /></div>
</form>
		</div>
	
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</div>

    
  </content>

</page>