COVID Health Check

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Covid-19 Health Declaration

Thank you for helping us to keep our doors open!

Please check any boxes that apply to you.

Have you been in contact with anyone who is now suspected of/confirmed to have COVID-19

Has your child's school been temporarily suspended/closed due to a CODID-19 related exposure?

Has your child been unable to attend school because of COVID-19 related symptoms?

Do you have a fever, fatigue or weakness?

Have you lost the sensations of smell of taste?

Do you have a headache?

Do you have gastrointestinal discomfort (abdominal pain, diarrhea, vomiting)?

Do you have shortness of breath, sore throat, or cough?

Have you travelled outside Ontario in the last 14 days?

None of the above apply to me.

First Name

Last Name

Email

I declare that the info I’ve provided is accurate & complete

Thank you for taking the time to complete this survey!

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