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COVID-19 Disclosure Form

    A disclosure of information regarding the possible exposure or contraction of COVID-19 to ensure safety of staff, members and general public entering Pavilion's spaces.

    As you are all aware, the virus can be transmitted by asymptomatic people and accordingly the statements made by the signee contained in this document cannot provide certainty that the virus will not be transmitted. Pavilion is taking prudent steps to impose and enforce appropriate protocols to keep members, staff and guests safe, but there can be no assurance that the virus won’t be contracted by members, staff and guests. This is a risk that the signee must assess themselves, and if they choose to come to Pavilion, to take the risk of either contracting the virus or transmitting it to others.

    In the past 14 days, have you or anyone in your household had:*
    Sudden onset of respiratory illness (congestion, nasal drainage, difficulty breathing)?
    Fever (temperature greater than 38°C)?

    Cough and/or sore throat?

    Have you or anyone in your household travelled outside of Canada in the past 14 calendar days? *
    Please confirm below*


    Please fill out the following*