West Coast Flying Trapeze COVID-19 Screening Form

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This questionnaire, based on the BC COVID-19 Self-Assessment Tool.

Each day please complete this questionnaire prior to arriving at every class.

You or your child will not be admitted to the school if the form has not been completed.

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Student's full name: *

Are you, your child, or anyone in your household experiencing any of the following: *

Fever

Chills

New or worsening cough

Shortness of breath

New muscle aches or headache

Sore throat

Have travelled outside of Canada within the last 14 days

Have been in close contact with a person who tested positive for COVID-19

Recent loss of smell or taste

None of the above

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