Covid-19 Daily Health Form

Which programs are you attending?

Private Swim Lesson at Snug Point Pool

TBCA Member Swim Lessons

TBCA Member Aqua Fit

Open Water Program

Have you or anyone in your household travelled outside of Canada in the past 14 days?

Yes

No

In the last 14 days, have you had contact with someone who has had symptoms such as cough and/or fever, or been diagnosed with Covid-19?

Yes

No

Have you or anyone in your household experienced any of the following symptoms in the last 14 days?

Fever/Temperature above 104F

Cough and/or sore throat

Respiratory illness and/or difficulty breathing?

I have experienced NO symptoms

Covid-19 Daily Health Screen Form