IN-PERSON SERVICE REGISTRATION

First Name

Last Name

Email Address

Phone Number

Service Date Service DateApril 17th, 2022May 8th, 2022May 15th, 2022May 22th, 2022May 29th, 2022

Have you traveled outside of Canada or had close contact with anyone that has traveled outside of Canada in the past 14 days? Have you traveled outside of Canada or had close contact with anyone that has traveled outside of Canada in the past 14 days? Yes No

Have you experienced a cough, shortness of breath, sore throat, chills, or a fever in the last 72 hours? Have you experienced a cough, shortness of breath, sore throat, chills, or a fever in the last 72 hours? Yes No

Have you had close contact with anyone with respiratory illness, a confirmed or probably case of COVID-19? Have you had close contact with anyone with respiratory illness, a confirmed or probably case of COVID-19? Yes No

Do you commit to opt out of attendance if the answer to any of the above questions change during the period (month) of my registration? Do you commit to opt out of attendance if the answer to any of the above questions change during the period (month) of my registration? Yes No

It is mandatory that every guest wears a mask. Do you agree to wear a mask at all times in the building? It is mandatory that every guest wears a mask. Do you agree to wear a mask at all times in the building? Yes No

We are taking the Ontario government's recommendations for resuming in-person gatherings very seriously. Do you consent to these protocols? We are taking the Ontario government's recommendations for resuming in-person gatherings very seriously. Do you consent to these protocols? Yes No