Proof of COVID Vaccination (Stratford Rotary Hockey League)

Print Proof of COVID Vaccination

Please fill out the fields below and submit a copy of your most recent vaccination record. If you are fully vaccinated, please only upload the record for the last shot. If you have a single-dose please submit the receipt for that dose and provide the date of your eligibility of second dose. This form is to be submitted by all Players/Coaches/Board Members who are born in 2009 or earlier.

Identification

Identify your participant Role in Rotary Hockey^*
Player (born 2009 or earlier)
Coach / Assistant Coach / Bench Staff
Board / Convenor
Only active participants are to use this form. Parents and spectators please do not to use this form.
First Name^*
Last Name^*

Date of Birth^*

Open the calendar popup.

Email Address^*

Confirmation of submission will be sent to this address
Contact Phone Number^*

Example ###-###-####

Vaccination

Please note that this information is being collected solely for the purpose of verifying your vaccination status and will only be accessed by authorized Stratford Rotary Hockey personnel and will not be shared with anyone.

Indicate the participant's vaccination status^*
Fully Vaccinated
First Dose Only
Alliance Hockey exemption granted
Attached proof of vaccination^*

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.
If you are fully vaccinated, we only need proof of your last shot. If you are exempt. please provide a copy of your exemption from Alliance Hockey