Full Name
*
First Name
Last Name
Email
*
example@example.com
Student Number
*
Local Phone Number
-
Area Code
Phone Number
Please select your location:
*
Toronto
Vancouver
Student Declaration
I declare that I have not travelled outside of Canada in the past 14 days.
*
True
False
I declare that I have not been in contact with a person infected with COVID-19 or in isolation for symptoms of COVID-19 in the past 14 days.
*
True
False
I declare that I have not had cold or flu symptoms in the past 14 days (fever, cough, sore throat, difficulty breathing).
*
True
False
I declare that I will not enter ILAC campuses if I am sick or have cold or flu symptoms (fever, cough, sore throat, difficulty breathing).
*
True
False
I consent to having my temperature taken upon entering any ILAC campus and may be prohibited from entering if I have a temperature outside the normal range (37.8 C).
*
Yes
No
I understand that masks must be worn at all times, hygiene protocols must be followed, and physical distancing requirements of staying six feet apart from each other must be observed while on campus at ILAC. Failure to follow the above procedures will result in being denied entry to the campus.
*
Yes
No
I declare that I will inform ILAC immediately if I have symptoms of COVID-19 or am in contact with anyone displaying COVID-19 symptoms.
*
True
False
I declare that I am fully and personally responsible for my own safety and actions while in, or around ILAC campuses and that using ILAC facilities may lead to unintentional exposure to COVID-19.
*
True
False
Signature
*
Submit
Should be Empty: