Health Assesment & Waiver
Please take a minute to fill in the following info
First Name
Last Name
Email
Phone Number
Are you experiencing any of the following symptons?
Fever/Chills
Nausea
Cough
Shortness of Breath
Runny Nose
Headache
Muscle Aches/Joint Pain
Loss of Taste or Smell
None Of The Above
Is anyone you live with or have had "close contact" with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
Yes
No
Have you travelled out of the following province within the last 14 days?
Yes
No
I agree to the terms & conditions
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