COVID 19 Form | Guiding Light Autism

Screening Questions (Check if yes)

In the last 14 days, have you or anyone you live with travelled outside of Canada?

Has a doctor, health care provider, or public health unit told you that you should be currently isolating (stay at home)?

In the last 14 days, have you been identified as a "close contact" of someone who currently has COVID19?

In the last 14 days, have you received a COVID Alert exposure notification on your mobile phone?

Are you and/or your child currently experiencing any ONE of these symptoms? - Fever of 37.8 or chills, cough or barking cough (croup), shortness of breath, decrease or loss of smell/taste, sore throat, difficult swallowing, runny or stuffy/congested nose, pink eye, headache, digestive issues such as nausea/vomiting, diarrhea, stomach pai

Is anyone you live with currently experiencing any new COVID19 symptoms and/or waiting for test results after experiencing symptoms?

Covid-19 Health Declaration

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