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COVID-19 Health Declaration
First Name
Last Name
Email
I am not experiencing any symptoms: fever, new or worse cough, sore throat, shortness of breath, difficulty breathing, fatigue, runny nose or nasal congestion, loss of or reduced sense of smell or taste, headache, sneezing, pink eye, hoarse voice, muscle aches, chills, nausea/vomiting, diarrhea, stomach pain, delirium, or in children sluggishness or lack of appetite.
I am not awaiting the results of a COVID-19 test.
I have not travelled outside of Ontario in the last 14 days.
I have been fully vaccinated against COVID-19 for more than 14 days.
Initials
Date
I declare that the info I’ve provided is accurate & complete
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