SCREENING CHECKLIST

Please fill out the following form prior to your weekly lesson

Does the person attending the activity have any of the following symptoms: fever, cough, shortness of breath/ difficulty breathing, sore throat, chills, painful swallowing, runny nose/nasal congestion, feeling unwell/fatigued, nausea/vomiting/diarrhea, unexplained loss of appetite, loss of sense of taste or smell, muscle/joint aches, headache, or conjuntivitis.
Have you, or anyone in your household, travelled outside of Canada in the last 14 days?
Have you or your children attending the program had close contact with someone who is ill with cough and/or fever?
Have you or anyone in your household been in close contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? 

Thanks for submitting!