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General Disclosure Form

Location *

Resident and employee health and safety is taken very seriously at PARC Retirement Living. 

Please complete the following screening questions not more than 24 hours  prior to your visit. 

Reason for Visit

Vaccination Status

You are fully vaccinated if if you have two doses of any of the World Health Organization approved COVID-19 vaccines or one dose of the Janssen COVID-19 vaccine.

International Travel

COVID-19 Testing Results

COVID-19 Symptom Check

To keep our residents and staff safe, please carefully assess for symptoms daily.

I certify the information above is complete and accurate. I acknowledge that the information on this form will be kept securely stored and encrypted on Colib website, viewable by the organization I plan to visit.

Signature :

To All Visitors,

Upon arrival, please go directly to the Front Desk to have your temperature taken. 

You will also be asked to show proof of your COVID-19 vaccination.  If you have provided your proof of vaccination at an earlier visit, you may not be asked to show it again.   

Thank you,

PARC Retirement Living