EDCC COVID-19 Screening Form
This form MUST be completed prior to each entry of Elmira & District Curling Club facility.
• If you answered NO to all questions from 1 through 4, (and if applicable 1-8), you may enter the building.
• If you answered YES to any questions from 1 through 4, (and if applicable 1-8), DO NOT enter the building. Stay home to self-isolate immediately and contact your health care provider or Telehealth Ontario (1 866-797-0000) to find out if you need a COVID-19 test.

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Date of Visit: *
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First and Last Name: *
Phone Number: *
Are you fully vaccinated against COVID-19 OR have you been cleared after testing positive for COVID-19 in the last 90 days? *
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