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Assumption of Risk and Waiver of Liability Relating to Coronavirus/Covid-19


This waiver and declaration must be completed prior to the commencement of the 2020/2021 hockey season to be eligible to participate in any activities, programs, and/or services organized by the London Ice Dawgs Youth Hockey Club Inc.

The novel coronavirus, COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is known to spread mainly by contact from person to person. Consequently local, provincial and federal governments recommend various measures and prohibit a variety of behaviors to reduce the spread of the virus.

The London Ice Dawgs Youth Hockey Club Inc. commit themselves to complying with the requirements and recommendations of the Federal, Provincial and Municipal governments as well as the local Public Health Unit, and have put in place and adopted all necessary measures to that effect. However, the London Ice Dawgs Youth Hockey Club Inc. cannot guarantee that you, your child, family members or any other member of your household will not become infected with COVID-19. Further, attending the activities, programs and/or services could increase the risk of contracting COVID-19 despite all preventative measures put in place.

By completing this document,
  1. I acknowledge the highly contagious nature of COVID-19 and I voluntarily assume the risk that I, my child, family members and any other member of our household could be exposed to or infected by COVID-19 by participating in any activities, programs and/or services held by The London Ice Dawgs Youth Hockey Club Inc.
  2. I declare that my child is participating voluntarily in the London Ice Dawgs Youth Hockey Inc. activities, programs and/or services.
  3. I declare that I, my child, family members or anyone in our household have not experienced cold or flu-like symptoms in the last 14 days (including fever, cough, sore throat, respiratory illness, difficulty breathing).
  4. I declare that if I, my child, family members or anyone in our household experiences any cold or flu-like symptoms after submitting this declaration, I will ensure that I, my child, family members or anyone in our household will not attend any activities, programs and/or services operated by the London Ice Dawgs Youth Hockey Club Inc. for a minimum of 14 days since those symptoms were last experienced.
  5. I declare that if I, my child, family members or anyone in our household is diagnosed with a positive Covid-19 Coronavirus test that I will inform the London Ice Dawgs Youth Hockey Club Inc. immediately with those test results.
  6. I declare that I, my child, family members or anyone in our household have not travelled outside of the Province of Ontario in the past 14 days.
  7. I acknowledge that if I, my child, family members or anyone in our household travels outside the Province of Ontario after submitting this declaration, I will ensure that I, my child, family members or anyone in our household does not attend any activities, programs and/or services operated by the London Ice Dawgs Youth Hockey Club Inc. for a minimum of 14 days has passed since the date of return.
  8. I declare that I, my child, family members or anyone in our household agree to follow the requirements and recommendations of National, Provincial and local Public Health Units and all other governmental authorities as well as all rules and safety regulations put in place by the London Ice Dawgs Youth Hockey Club Inc. or any of its facilities whether pertaining to COVID-19 or not, and to adopt all necessary measures to that effect.
  9. I understand that due to Covid-19 there is a possibility of a government shut down and although the London Ice Dawgs Youth Hockey Club Inc. will make every effort to ensure the completion of the season, there will be no guarantee to this effect and the London Ice Dawgs Youth Hockey Club Inc. will not be held accountable or responsible for any lost ice times, activities or programs due to Federal, Provincial or Municipal government rulings.
  10. I acknowledge that I, my child, family members and anyone in our household agree that by completing this waiver and agreeing to the terms and conditions set out within it, hereby forever discharge and indemnify the London Ice Dawgs Youth Hockey Club Inc., its servants, officers, directors, sponsors and employees from any claims, damages or actions which may arise in the event that myself, my child, family members or any other member of our household contract Covid-19 Coronavirus.
This document will remain in effect until the London Ice Dawgs Youth Hockey Club Inc. receives direction from the federal, provincial and municipal governments and the Public Health unit that this declaration is no longer required.

This document is in addition to and does not replace any other waivers in place by the London Ice Dawgs Youth Hockey Club or any of its constituents.


I declare that I (we) have read and understand this waiver and am completing this document freely and with full knowledge.

First NameLast name
Name of Player 1:

Name of Player 2:

Name of Player 3:





Name of Parent or Guardian 1:

Name of Parent or Guardian 2: