COVID-19 WAIVER

PLEASE REVIEW AND SIGN OUR MANDATORY COVID-19 LIABILITY WAIVER

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

ADDRESS

2-5230 Harvester Road, Burlington, ON L7L 4X4

CANADA

*Unit faces the Appleby GO station

CONTACT

Tel: 289-683-7653

HOURS

OPEN DAILY

10AM-10PM

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Est. 2013 May 13 - With love