COVID-19 Health Declaration & Class Check In

Please fill out the following COVID-19 Health Declaration form in order to participate in our activity. Submissions must be made ON THE DATE of your activity, prior to the activity.

Have you been a household contact of a case1 of COVID-19 in the last 14 days?

A household contact according to AHS : a person who lives in the same residence as the case OR who has been in frequent, long-duration, close-range interaction with a case of COVID-19. For example, someone who is a caregiver or an intimate partner of a COVID19 case.

As per AHS , if you answered “YES” AND you are NOT fully immunized please stay home for 14 days from the last day of exposure and monitor for symptoms. 

Are you experiencing any of the following:

  • Fever

  • Cough

  • Shortness of breath

  • Runny nose

  • Sore throat

  • Chills

  • Painful swallowing

  • Nasal congestion

  • Feeling unwell / fatigued

  • Nausea / vomiting / diarrhea

  • Unexplained loss of appetite

  • Loss of sense of taste or smell

  • Muscle / joint aches

  • Headache

  • Conjuntivitis

I agree to provide the following in accordance with the Alberta Restrictions Exemtption Program and with the City Of Calgary Vaccine Passport Bylaw 65M2021:

Your Healthy Check In Form Has Been SUBMITTED!

Thank you for helping to keep us all healthy and training!

Bobur Mamadjanov