LCBA COVID-19 ATTESTATION
The form below is to be completed prior to attending any LCBA session or event by the participant or participants guardian:
Email address *
Participant Full Name (First & Last); *
Participant Guardian Name (if Participant is a minor);
Participant LCBA Division *
Participant Activity Date *
MM
/
DD
/
YYYY
Does the participant knowingly have COVID-19; *
Is the participant experiencing any known symptoms of COVID-19, such as fever, cough, shortness of breath or malaise; *
Has the participant traveled outside of Canada in the last 14 days; *
Has the participant frequented a COVID-19 high risk area in the Province during the last 14 days; *
Has the participant, in the past 14 days, knowingly come into contact with someone who has COVID-19, who has known symptoms of COVID-19, or is self-quarantining after returning to Canada *
IF YOU HAVE ANSWERED YES...
IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS - PLEASE DO NOT ATTEND ANY LCBA ACTIVITIES. PLEASE CALL 811 AND SPEAK TO AN AHS NURSE ABOUT YOUR SYMPTOMS
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