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Daily Screening Questionnaire
Do you, or your child/ren attending the program, have any of the below symptoms?

*If you clicked on any of the above except none, STOP and call Stacey prior to sending your child.

Has this child/ren travelled outside of Canada in the last 14 days?
Has your child/ren attending the program had close, UNPROTECTED contact (face-to-face contact within 2m/6ft without protective equipment), with someone who is ill with cough and/or fever?
Have you or anyone in your household been in close UNPROTECTED contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?

*If you clicked YES to any of the above, STOP and call Stacey prior to sending your child.

Thanks for submitting your screening form. Our staff will have a copy of this form online when you come drop off your child.

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