Covid-19 Screening & Vaccine Declaration for In-Person Class

As a team, the SHINE staff have decided to conduct Fitness Training sessions both online and in-person to include as many people as possible. All Participants can choose what they want to participate in, based on their level of comfort in the current circumstances.

THIS MUST BE FILLED OUT WITHIN 24 HOURS BEFORE EVERY IN-PERSON CLASS

Covid-19 Health & Vaccination Declaration

First Name

Last Name

SYMPTOMS & CONTACT: I have NOT had a new onset cough, sore throat, shortness of breath, fever (temperature of 37.8 C or higher), or chills (onset in the last 7 days). I have not had any new symptom of a respiratory illness (onset in the past 7 days) including: a runny nose, sneezing, nasal congestion (not due to allergies), or, unexplained fatigue or malaise, or, nausea, diarrhoea, or, changes in my sense of taste/smell. I haven’t been in close contact with a Covid-19 patient in the last 14 days or advised by Public Health to self-isolate

VACCINATION: I certify I am fully vaccinated against Covid-19, which means I have received two doses of a government-approved vaccine 14 or more before the date of class. I will show proof of my vaccination status or a medical reason for not being vaccinated against COVID-19 (i.e. doctor’s note or equivalent), along with a government-issued ID upon check-in.

RISK ACKNOWLEDGEMENT: I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending a SHINE Class and such exposure or infection may result in personal injury or illness. I understand the risk of becoming exposed may result from the actions, omissions, or negligence of myself and others. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself. I hereby release, covenant not to sue, discharge, and hold harmless SHINE Strength & Confidence Inc, and its rental facilities, instructors, employees, and partners for any claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.

I agree that if I, at any time, test positive for COVID-19, I will notify SHINE Strength & Confidence Inc. immediately and will not participate in any in-person classes or events until I have permission from public health to resume normal public activities.

I agree to adhere to SHINE's Physical Distancing policy and remain in your assigned sqaure until directed to exit the building.View Physical Distancing Policy & Safety Procedures

Date

e-Signature

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!