COVID Vaccination Status

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We are collecting this information solely for the purpose of making the best decisions with regard to hockey when a team member, coach, or other key contact tests positive for COVID. Please note that this survey is to be completed by all coaches and volunteers (one survey per person).

Email *

Full Name *

Team or Teams you are associated with *

8U C

8U White

8U Red

10U White

10U Red

10U Black

12U White

12U Red

12U Black

12U Gold

12U Silver

14 Girls

14 White

14 Red

14U Black

16U White

16U Red

16U Black

18U White

Required

Role *

Coach

Manager or other high contact volunteer

Required

Current Vaccination Status (If your status changes after completing the survey, please notify Cari Bixler at cari@adambixler.com so we can update our records.) *

Fully vaccinated

Partially vaccinated

Unvaccinated

Prefer not to answer. Please note for planning purposes, this will be treated as unvaccinated.

A copy of your responses will be emailed to the address you provided.

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