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Vaccination Passport for Parents

The London Ice Dawgs Youth Hockey Club Inc. will require PROOF OF VACCINATION from all members of management, head instructors, volunteers (both on and off the ice), referees and frequent visitors such as parents/guardians of registered members before participating in any events or activities for the 2021/2022 season.
  • Parents/Guardians will have until November 1st to provide proof of full vaccination. After this time we will require an accepted medical or religious/protected grounds exemption form to gain entry to our program.
  • Exemption documents for medical or religious/protected grounds are available. Please ensure you understand our policy on these forms.

  • Anyone who cannot meet these requirements may request a refund.

  • Refund requests must be made in writing and received no later than September 24, 2021 to receive a full refund.
  • Refund requests after September 24th but before the first scheduled ice time, will be less an administration fee and a uniform fee.
  • There is no refunds once the first scheduled ice time begins.

Thank you for your cooperation and understanding in this matter.



If you have signed up to volunteer, you MUST use the Coaches & Volunteers Vaccine Passport form.


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: