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

Print OFFICIALS - ON ICE AND OFF ICE VACCINE CONFIRMATION

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

Personal Information

Enter information below.

Role with WMHA Officials

Enter information below.

Are your a Timekeeper or On Ice Official? ^*
TIMEKEEPER
ON ICE OFFICIAL (ie, Referee or Linesmen)

VACCINE INFORMATION

Please answer the questions below.

Have you had your first dose of an approved COVID-19 Vaccine? ^*
YESNO
Have you had your second dose of an approved COVID-19 Vaccine? ^*
YESNO
Have you been granted a vaccine exemption from ALLIANCE Minor Hockey based on medical or creed/religious purposes?^*
YESNO

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.