September 1, 2020

I, the undersigned, attest to the following: (please initial beside each applicable attestation)

  • To the best of my knowledge, I do not have the novel coronavirus COVID-19 or any variant of the novel coronavirus COVID-19, nor have I had it within the past 14 days
  • To the best of my knowledge, I have not been exposed to someone who has the novel coronavirus COVID-19 or any variant of the novel coronavirus COVID-19 within the past 14 days
  • Within the past 14 days, I have not experienced any of the following that are new and not related to allergies or pre-existing conditions: persistent cough, fever higher than 38 degrees Celsius (98.6 degrees Fahrenheit), shortness of breath, sore throat, flu-like symptoms, runny nose
  • I have not travelled outside Canada during the past 14 days

By signing below, I confirm my understanding that I may be refused participation in, or be asked to leave, this trip/course, with no option for refund of payment, if any of the above attestations are found to be incorrect or if the status of those attestations changes between the time of signing of this form and any time before the end of the trip/course.