Declaration of Compliance - COVID-19
Bowls Canada Boulingrin, its provincial/territorial organizations, and affiliated clubs (collectively the “Organization”) require the disclosure of exposure or illness in order to safeguard the health and safety of all participants and limit the further spread of COVID-19. This Declaration of Compliance will be kept safely, and personal information will not be disclosed unless as required by law or with your consent.

An individual (or the individual’s parent/guardian, if the individual is younger than the age of majority) who is unable to agree to the terms outlined in this document is not permitted to enter the Organization’s facilities or participate in the Organization’s activities, programs, or services.

This declaration must be completed for each date of participation and should not be submitted until the date of participation.
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Email *
Participant First Name *
Participant Last Name *
Is the participant a minor?
Parent/Guardian First Name
Only needed for minor participants
Parent/Guardian Last Name
Only needed for minor participants
Phone
Date *
This declaration is only valid for today's date.
MM
/
DD
/
YYYY
Have you or anybody in your household experienced the following symptoms in the previous 14 days? *
If you answer yes to any of these questions, do not proceed. You should not attend at the organization until you have consulted a healthcare professional.
Yes
No
Chills
Body aches
Difficulty breathing
Loss of smell
Fever
Fatigue
Respiratory illness
Loss of taste
Vomiting
Pink eye
Diarrhea
New or worsening cough
Nausea
Acknowledgements
I, the undersigned being the individual named above and the individual’s parent/guardian (if the individual is younger than the age of majority), hereby acknowledge and agree to the terms outlined in this document. The coronavirus disease COVID-19 has been declared a worldwide pandemic by the World Health Organization and COVID-19 is extremely contagious. The Organization has put in place preventative measures to reduce the spread of COVID-19 and requires all individuals (or their parent/guardian, when applicable) to adhere to the compliance standards described in this document.
*
If you cannot positively acknowledge all applicable rows,  do not attend the organization until you are able to do so.
Acknowledged
N/A
This document will remain in effect until the Organization, per the direction of the provincial government and provincial health officials, determines that the acknowledgements in this Declaration of Compliance are no longer required.
The Organization may remove me from the facility or from participation in the activities, programs or services of the Organization at any time and for any reason if the Organization believes, in its sole discretion, that I am no longer in compliance with any of the standards described in this document.
I have not, nor has any member of my household, travelled to or had a lay-over in any country outside Canada, or in any province/territory outside of my province/territory of residence in the past 14 days. If I or anyone in my household travel, outside of our province/territory of residence after submitting this Declaration of Compliance, I will not attend any of the Organization’s facilities, activities, programs or services until at least 14 days have passed since the date of return.
I am attending or participating voluntarily and understand the risks associated with COVID-19. I (or my parent/guardian, on behalf of me (when applicable)) agree to assume those risks, including but not limited to exposure and being infected.
I am following recommended guidelines, including but not limited to, practicing physical distancing, trying to maintain separation of two metres from others, adhering to recognized hygiene best practices, and otherwise limiting exposure to COVID-19
I have not been diagnosed with COVID-19,or if I have been diagnosed with COVID-19 I have been cleared as non-contagious by provincial or local public health authorities.
I will will follow the safety, physical distancing and hygiene protocols of the Organization.
If I experience, or if anyone in my household experiences, any signs or symptoms of COVID-19 after submitting this Declaration of Compliance, I will immediately isolate, notify the Organization, and not attend any of the Organization’s facilities, activities, programs or services until at least 14 days have passed since those symptoms were last experienced.
If I am a front-line worker (such as hospital staff, long term care staff, or other individual who interacts with individuals who have confirmed or suspected cases of COVID-19), I confirm that I have worn proper and approved Personal Protective Equipment at all times whenever I have interacted with an individual who has a confirmed or suspected case of COVID-19 in the last 14 days.
If I am not a front-line worker, I have not been exposed to a person with a confirmed or suspected case of COVID-19 in the last 14 days.
By submitting this form, I affirm that all responses are true and that my submission has the same force as if signed and made under oath.
A copy of your responses will be emailed to the address you provided.
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