COVID-19 SCREENING FOR RESIDENTIAL VISITS

Please fill out the following health declaration form in order to participate in our activity. Submissions are only valid the day of your visit.
Are you experiencing any of the following symptoms: sore throat, hoarse voice, difficulty swallowing, affected sense of smell or taste, chills, headaches, fatigue, diarrhea, abdominal pain, nausea, vomiting, pink eye, runny nose/sneezing, nasal congestion, new cough, fever, shortness of breath?
Have you recently worked in a location that is currently experiencing an outbreak where you’ve been asked to self-isolate while at work?
Have you traveled internationally within the last 14 days (outside Canada)?
Have you had close contact with a confirmed or probable COVID-19 case or Have you had close contact with a person with acute respiratory illness or who has been outside Canada in the last 14 days?

Supporting over 150 infants, children and adults living with a developmental disability in our community.

Email: info@clkd.ca

Phone: 519-396-9434

Registered Charity: 889487849RR0001

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CLKD adheres to the Canadian Anti-Spam Legislation (CASL) and will not share your address with outside parties.

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