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West Nipissing Child Care Corporation
Required Covid-19 Screening
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Required Covid-19 Screening
ALL STAFF, PARENTS, ADULTS AND CHILDREN MUST SELF-IDENTIFY BEFORE WE ACCEPT YOUR CHILD IN OUR SERVICE.
Please answer the following questions: Check the appropriate box. Thank you.
Does your child have any of the following symptoms: fever, cough, difficulty breathing, muscle aches, fatigue, headache, sore throat, runny nose, or atypical symptoms such as; altered mental status and inattention, falls, abdominal pain, diarrhea, nausea, vomiting, chills, exacerbation of chronic symptoms or croup?
*
Yes
No
Not applicable
Within the past 14 days, have you been in direct contact with someone who is experiencing COVID-19 symptoms and self-isolating as a result of it /or with someone with a confirmed case of COVID-19?
*
Yes
No
Within the past 14 days have you traveled outside the country or have you been in contact with someone that has been out of the country?
*
Yes
No
If you have answered yes to any of the above questions or have refused to answer:
Your child will not be permitted to attend the child care center.
Please indicate which child care your child attends.
*
La tanière des tout-petits
Service de garde des louveteaux
La niche des lionceaux
Centre-based
White Woods
La ruche des petites abeilles
EarlyON
Not applicable
Comments
By submitting this form I certify that the above statements are true and valid.
Name
*
First
Date
*
Date Format: MM slash DD slash YYYY
Telephone
*
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