Vaccine Proof and Sign Off (Tillsonburg Minor Hockey Inc.)

All Coaches/Officials/Volunteers/Board Members and Players born in 2009 or later are required to be fully vaccinated by October 31, 2021. Fully vaccinated is when both doses have been received and it has been at least 2 weeks from the date of the second dose.

I understand that if I decline the vaccine, I will not be able to participate in any TMHI Hockey events as per the policy outlined by OMHA and/or OWHA which TMHI is governed to implement.

I understand that the purpose of collecting and reporting the information contained in this document is consistent with all applicable legislation.

I agree to the terms and conditions stated above^*

First Name^*

Required

Last Name^*

Required

Email Address^*

Required

Select all Roles that Apply^*

Player
Coach
Trainer
Assistant Coach
Manager
On Ice Helper
Off Ice Volunteer
Referee
Time Keeper
Board Member

Check All That Apply

Division ^*

IP (U5, U6, U7, U8)
Novice U9
Atom U11
Peewee U13
Bantam U15
Midget U18
All divisions

Required

Are you fully vaccinated? ^*

Yes, I am full vaccinated and will upload my vaccine receipts
I have received 1 dose so far. I will provide proof of vaccination to TMHI by October 31, 2021. I will upload my first vaccine dose receipt now.
It is my decision to DECLINE the vaccination at this time and request a refund if applicable for the 2021-2022 TMHI hockey season. Once a refund is requested the registrant will not be eligible for reinstatement until the 2022-2023 hockey season.

Required

Vaccine Receipt - Dose 1

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 1. Maximum File Size: 4MB.

Dose 1 receipt only required for those that have not had Dose 2

Vaccine Receipt - Dose 2

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 1. Maximum File Size: 4MB.

Vaccine Proof and Sign Off (Tillsonburg Minor Hockey Inc.)

OMHA Digital Network

Get Mobile!

Contact Us