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Declaration

 Pre-Trip/Course Declaration of Health and Exposure

Members of the ACMG take the safety of their guests and employees, and the prevention of the spread of the COVID-19 pandemic very seriously. As such, you are required to make four attestations below. The inability to make one or more of these attestations may disqualify you from participation.

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 is 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 traveled 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.

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Name of participant (please print)

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Signature of participant

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Date

 

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