Covid Screening Form
Please submit this Covid screening before attending each session to help us keep your family and our clinic safe.
If you answer 'Yes' to any of the below, please do not enter the premises but contact the office at 289 678 0581 to switch to a virtual session or to reschedule your appointment.
Are you currently experiencing any of the following NEW or WORSENING symptoms that are NOT related to other known causes or conditions (eg allergies, chronic conditions):
Fever - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
Runny or stuffy nose
Cough (barking cough, whistling when breathing)
Shortness of breath
Sore throat or difficulty swallowing
Decrease or loss of taste or smell
Headache that is unusual or long-lasting
Digestive issues like nausea/vomiting, diarrhea, stomach pain
Muscle aches that are unusual or long-lasting
Extreme tiredness that is unusual
Sluggishness and lack of appetite
None of The Above
Have you travelled out of Canada in the past 14 days?
Have you tested positive for Covid-19 in the past 14 days?
In the last 14 days, have you been in close physical contact with someone who currently has a confirmed case of COVID-19?(This includes getting a COVID Alert exposure notification. Close physical contact means: being less than 2 metres away in the same room, workspace, or area; living in the same home; being in the same classroom)?
PARENTS BRINGING CHILD/REN TO A PROGRAM: I acknowledge that I am responsible for applying sunscreen to my child prior to arrival. I consent to NowWhat Staff reapplying paraben-free, scent-free sunscreen to my child as needed throughout the day (NowWhat will provide the sunscreen to limit the number of personal items on site).
I understand and agree to the NowWhat sunscreen policy
This does not apply to me (applies only to guardians of children in outdoor programs)
Send me a copy of my responses.
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