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Contact information

Registration for Yoga at Africville, July 14th at 8:00am

Name *

Email *

Address *

Phone number

Are you currently required to self-isolate by order of your doctor or Nova Scotia due to Covid-19? *

Yes

Have you knowingly been in contact with anyone who has tested positive for COVID-19, with anyone who is waiting for COVID-19 test results, anyone who you suspect has symptoms of Covid -19 or anyone who should be self-isolating within the last 14 days? *

Yes

Have you travelled outside of Nova Scotia in the past 14 days? *

Yes

Have you been to any of the locations identified by NS Public Health as potential exposure sites (during dates and times listed) and are you following all current restrictions as applicable? *

Yes

Have you in the last 48 hours experienced or are you currently experiencing either of the following symptoms? *

Fever

Cough

None of the above

Have you in the last 48 hours experienced or are you currently experiencing either of the following symptoms (new or worsening)? *

Sore throat

headache

shortness of breath

runny nose

none of the above

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