TSO Health Attestation Form 2020
The following questions must be answered by each individual/parent prior to entry to the Music School.
The answers to all questions must be “NO” in order to attend lessons or rehearsal. To protect your data, all information collected will be kept private and confidential.

Do you have any of the following symptoms?
Please Enter First and Last Name *
Enter Today's Date *
MM
/
DD
/
YYYY
Enter the current time (EST) *
Time
:
Fever (temperature of 37.8C or greater) *
New or worsening cough *
Shortness of Breath *
Sore throat *
Difficulty swallowing *
Loss of sense of taste or smell *
Nausea/vomiting/ diarrhea, abdominal pain *
Runny nose or nasal congestion *
Unexplained fatigue *
Delirium *
Unexplained or increased number of falls *
Acute functional decline *
Exacerbation of chronic conditions *
Chills *
Headaches *
Croup *
Conjunctivitis *
Have you travelled outside of Canada or had close contact with anyone who has in the past 14 days? *
Have you had close contact in the past 14 days with anyone with a new cough, fever, or difficulty breathing, or a confirmed case of COVID-19? *
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