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Coaches & Volunteers Vaccination Passport

The London Ice Dawgs Youth Hockey Club Incorporated will require PROOF OF VACCINATION from all members of management, head instructors, referees and volunteers (both on and off the ice) before participating in any events or activities for the 2021/2022 season.

If you have signed up to volunteer, you MUST sign this form before the season begins.


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 have read and understand this waiver and am completing this document freely and with full knowledge.

First NameLast name
Date of 2nd dose:

Name of Player 1:
Name of Player 2:
Name of Player 3: