GLGC Student COVID Screening
COVID-19 Health Screening- * VERSION 1: August 26, 2021

Each child must have their own screening tool completed, so if you have multiple children, you will have to complete it multiple times.
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Email *
Parent name *
Childs name *
Is the student/child currently experiencing any of these symptoms?
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Did the student/child receive their final (or second in a two-dose series) COVID-19 vaccination dose more than 14 days ago, or have they tested positivefor COVID-19 in the last 90 days and have since been cleared? *
In the last 14 days, has the student/child travelled outside of Canada? *
Is someone that the student/child lives with currently experiencing any newCOVID-19 symptoms and/or waiting for test results after experiencing symptoms? *
In the last 10 days, has the student/child been identified as a “close contact”of someone who currently has COVID-19? *
In the last 10 days, has the student/child received a COVID Alert exposure notification on their cell phone? *
In the last 14 days, has the student/child travelled outside of Canada AND: 1) been advised to quarantine as per the federal quarantine requirements AND/OR 2) is the student/child under the age of 12 and not fully vaccinated? *
Has a doctor, health care provider, or public health unit told you that the student/child should currently be isolating (staying at home)? *
In the last 10 days, has the student/child tested positive on a rapid antigentest or a home-based self-testing kit? *
I acknowledge that if I answered yes to ANY of the questions above that I will not attend Great Lakes Gymnastics Center for classes, camps, or other events until I call Chatham-Kent Public Health at 519-352-7270. I also acknowledge that if I provide false information, I will be asked not to return to GLGC until I am re-invited. *
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