General Disclosure Form

First Name *

Last Name *

Location *

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

Please do not visit the community if you have symptoms of ANY communicable disease or have tested positive for COVID-19 in the last 5 days as per Public Health Orders.

COVID-19 Rapid Tests are available to all visitors. Please inquire at the Reception desk.

If you will be dining in the Dining Room or Private Dining Room, you will be expected to have tested yourself on the day of your visit or be tested when you arrive at the site.

Reason for Visit *

Do you have symptoms of ANY communicable illness, including but not limited to COLD, FLU, or COVID-19? *

NoYesNo

Have you tested positive for COVID-19 in the last 5 days? *

NoYesNo

You are considered to be fully vaccinated 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. You do not need to have a booster dose to be considered fully vaccinated.

I confirm that I am fully vaccinated (as defined be the BC Centre for Disease Control). *

NoYesNo

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 :

General Disclosure Form

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