21/22 - COVID19 Vaccine Certificate Submission (Sarnia Hockey)

Print 21/22 - COVID19 Vaccine Certificate Submission

Please fill out the fields and have your Provincial Vaccine Certificate(s) ready to upload. ONLY PDF will be accepted.

Personal Data

Please fill out all required fields

Confirmation Email Address

Example: [email protected] Your submission will be sent to this address.
Last Name^*
First Name^*
Middle Name(s)
Date of Birth^*

YYYY/MM/DD
Participant Type^*

Please Pick One
Division of Participation^*
U6/U7
U8/U9
U10/U11
U12/U13
U14/U15
U16/U18/U21
SHA Board of Directors
Game Officials
Other
Choose all that apply
Level of Participation^*
REPRESENTATIVE - A/AAREPRESENTATIVE - MDRECREATIONALI DO NOT KNOWNOT LISTED
Choose all that apply

Vaccine Dose #1

Date of Dose # 1

Agent Recieved
Please attached your Dose#1 Certificate

Allowed extensions: .pdf.
Maximum # Files: 1. Maximum File Size: 4MB.
PDF Format ONLY

Vaccine Dose #2

Date of Dose # 2

Agent Recieved
Please attached your Dose#2 Certificate

Allowed extensions: .pdf.
Maximum # Files: 1. Maximum File Size: 4MB.
PDF Format ONLY

Personal Submission

I am the person named at the top of this form and these are my Vaccine Certificates
Parent/Guardian Submission

I am a parent or guardian submitting the Vaccine Certificates for the person named at the top of this form

Human Validation