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COVID-19 Screening Waiver

I the undersigned affirm that I have not in the past 14 days:

  1. Left the country of Canada
    I Agree
  2. Tested positive for Covid-19 nor have I come into contact with anyone known or suspected to have Covid-19
    I Agree
     
  3. I do not have:
  • Fever
  • New onset of cough
  • Worsening chronic cough
  • Shortness of breath
  • Difficulty breathing
  • Sore throat
  • Difficulty swallowing
  • Decrease of loss of sense of taste or smell
  • Chills
  • Headaches
  • Unexplained fatigue/mailaise/muscle aches(myalgias)
  • Nausea/vomitiing, diarrhea, abdominal pain
  • Pink eye(conjunctivitis)
  • Runny nose or nasal congestion without other known cause
    I Agree
First Guests Name

First Name*

Last Name*

Phone*
First Guests Date of Birth*
First Guests Signature*
Second Guests Name

First Name*

Last Name*
Second Guests Date of Birth*
Third Guests Name

First Name*

Last Name*
Third Guests Date of Birth*
Fourth Guests Name

First Name*

Last Name*
Fourth Guests Date of Birth*
Fifth Guests Name

First Name*

Last Name*
Fifth Guests Date of Birth*
Sixth Guests Name

First Name*

Last Name*
Sixth Guests Date of Birth*
Seventh Guests Name

First Name*

Last Name*
Seventh Guests Date of Birth*
Eighth Guests Name

First Name*

Last Name*
Eighth Guests Date of Birth*
Ninth Guests Name

First Name*

Last Name*
Ninth Guests Date of Birth*
Tenth Guests Name

First Name*

Last Name*
Tenth Guests Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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