OFFICIALS - ON ICE AND OFF ICE VACCINE CONFIRMATION (Waterloo Minor Hockey)

OFFICIALS - ON ICE AND OFF ICE VACCINE CONFIRMATION

TO BE COMPLETED BY TIMEKEEPERS AND ON ICE OFFICIALS ONLY!!!

Personal Information

Enter information below.

Enter First Name^*

Required

Enter Last Name? ^*

Required

Role with WMHA Officials

Enter information below.

Are your a Timekeeper or On Ice Official? ^*

TIMEKEEPER
ON ICE OFFICIAL (ie, Referee or Linesmen)

Required

VACCINE INFORMATION

Please answer the questions below.

Have you had your first dose of an approved COVID-19 Vaccine? ^*

YESNO

Required

Have you had your second dose of an approved COVID-19 Vaccine? ^*

YESNO

Required

Have you been granted a vaccine exemption from ALLIANCE Minor Hockey based on medical or creed/religious purposes?^*

YESNO

Required

Proof of Vaccine or Exemption

Please upload your Dose Receipt or ALLIANCE Approved Exemption Form.

Please upload the proof of your vaccination - DOSE #1.

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.

A Dose Administration Receipt from the Government of Ontario or Physician's Official Record are the only 2 acceptable forms of proof.

Please provide a copy of the front of your Ontario Health Card?

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.

Please upload the proof of your vaccination - DOSE #2.

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.

A Dose Administration Receipt from the Government of Ontario or Physician's Official Record are the only 2 acceptable forms of proof.

Please upload your approved ALLIANCE Vaccine Exemption Form.

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.

An approved ALLIANCE Exemption Form is the only acceptable proof of exemption.

Confirmation

Please provide your email address to receive confirmation of form submission.

Please provide email address to receive proof of form submission.

Example: [email protected]. Your submission will be sent to this address.

OFFICIALS - ON ICE AND OFF ICE VACCINE CONFIRMATION (Waterloo Minor Hockey)

ALLIANCE HOCKEY Digital Network

Personal Information

Role with WMHA Officials

VACCINE INFORMATION

Proof of Vaccine or Exemption

Confirmation

Get Mobile!

Contact Us