PROOF OF VACCINATION/EXEMPTION - SUBMISSION FORM- PLAYERS ONLY (Waterloo Minor Hockey)

Print PROOF OF VACCINATION/EXEMPTION - SUBMISSION FORM- PLAYERS ONLY

Please complete form and attach proof of vaccinations. Please also provide a copy of your Ontario Health Card. This form is for PLAYERS ONLY! If you are Coach or Bench Staff or Volunteer, please find a form under the "COACHES" tab for you to submit your information. ALL DOCUMENTS WILL BE REVIEWED AND THEN DELETED FROM OUR RECORDS.

Personal Information

Enter information below.

Enter First Name^*
Enter Last Name?^*

Team Affliliation

What team do you play for or plan to play for this upcoming season? Enter information below.

Choose the team that you plan on playing with this season?

Choose your team - if you don't know what team you are going to play for yet, choose the team you think you will be playing with or enter the age group you are registered with, in the next section.
If you don't know what team you are with yet, please enter the age group you are registered in

ie - U15

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 upload a copy or picture 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: yo[email protected]. Your submission will be sent to this address.

NOTES

FOR OFFICE USE ONLY

YES OR NO
YESNO

Human Validation

Check The Box ^*

PROOF OF VACCINATION/EXEMPTION - SUBMISSION FORM- PLAYERS ONLY (Waterloo Minor Hockey)

ALLIANCE HOCKEY Digital Network

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