1. Name *
2. Email *



3. ARE YOU CURRENTLY EXPERIENCING ANY OF THESE SYMPTOMS?* * Fever and/or chillsCough or barking coughShortness of breathMuscle aches/joint painExtreme tirednessDecrease or loss of taste or smellRunny or stuffy/conjested noseSore throatHeadacheNausea, vomiting and/or diarrheaNone of the above



4. IN THE LAST 5 DAYS, HAS SOMEONE YOU LIVE WITH?* Been sick with symptoms associated with COVID-19? and/orTested positive for COVID-19 (on a rapid antigen test or PCR test)None of the above



5. IN THE LAST 5 DAYS, HAVE YOU TESTED POSITIVE ON A RAPID ANTIGEN OR HOME-BASED SELF-TESTING KIT* YesNo



6. IN THE LAST 5 DAYS, HAVE YOU RECEIVED A COVID ALERT EXPOSURE NOTIFICATION ON YOUR CELL PHONE? * YesNo



7. IN THE LAST 5 DAYS, HAVE YOU BEEN IDENTIFIED AS A “CLOSE CONTACT” OF SOMEONE WHO CURRENTLY HAS COVID-19? CONFIRMED BY A PCR OR RAPID ANTIGEN TEST* YesNo



8. IN THE LAST 14 DAYS, HAVE YOU TRAVELLED OUTSIDE OF CANADA?* YesNo



9. HAS A DOCTOR, HEALTH CARE PROVIDER, OR PUBLIC HEALTH UNIT TOLD YOU THAT YOU SHOULD CURRENTLY BE ISOLATING (STAYING AT HOME)? * YesNo



10. HAVE YOU BEEN IN CLOSE PHYSICAL CONTACT WITH SOMEONE EXPERIENCING SYMPTOMS OF COVID IN THE LAST 5 DAYS?* YesNo

* Required

** Please note if you've answered YES to any of the questions, your attendance is NOT permitted in class **