Vaccination Information 2021 (Mooretown Minor Hockey)

Print Vaccination Information 2021
Please fill out all sections & upload either a screen shot or scan of your proof of 2nd COVID vaccine. Your records will be kept confidential and only the MTMHA rep collecting will have access to them.
Information
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
  2. Example: [email protected] Your submission will be sent to this address.
MTMHA Position
Please use the drop down menu to identify as either a player, executive member or pick the appropriate age group (coach, manager, trainer etc)
1st Vaccine Info
If you have had both vaccines please skip this section & fill out the section below. If you have only had 1 please fill out this section.
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
Proof of 2nd Vaccine
Please upload your proof of 2nd vaccine. This information is kept confidential & not shared with anyone other than the person collecting on behalf of MTMHA.
  1. Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx.
    Maximum # Files: 1. Maximum File Size: 4MB.
    Please attach scan or screen shot of 2nd vaccine
Human Validation
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Printed from mooretownminorhockey.com on Tuesday, November 30, 2021 at 8:03 PM