SPRING 2021 PARADE OF HOMES

#PARADEOFHOMESMB

COVID-19 SHOW HOME PRE-SCREENING DECLARATION FORM

PART 1:

This declaration is made in connect with my/our attendance of:

Property Address

Date Visiting Address

PART 2:

I/WE confirm the following statements to be true(check all that apply):

A. I/WE have not been diagnosed with a lab-confrimed probable or positive case of the COVID-19 virus, or if I have been diagnosted with a lab-confrimed probable or positive case of the COVID-19 virus, in accordance with Provincal Health Guidelines, I have isolated for at least ten(10) days, and have recieved confirmation from a qualified public health offical that I am no longer required to isolate.

B. In the last 14 days I/WE have not travelled outside of Manitoba.

C. I/WE have not knowingly been in contact with anyone who travelled into Manitoba in the last 14 days from another jurisdiction.

D. I/WE do not have a new onset or worsening of any one (1) of the following symptoms from coloumn "A" or any two symptoms from coloumn "B".

COLUMN A SYMPTOMS(one symptom)

Fever/Chills
Cough
Sore throat/hoarse voice
Difficulty breathing
Loss of taste or smell
Vomiting or diarrhea for more than 24 hours

COLUMN B SYMPTOMS(two symptom)

Runny nose
Muscle aches
Fatigue
Pink eye(conjunctivitis)
Headache
Poor feeding, if an infant
Nausea or loss of appetite

E. I/WE have not knowingly come into contact with anyone experiencing any of the symptoms commonly associated with the COVID-19 virus as set out in 2(d) in the last 14 days.

F. I/WE have not knowingly come into contact with any person in the last 14 days who was previously diagnosed with a lab confirmed probable or positive case of the COVID-19 virus, unless the close contact occurred following the indicidual having self-isolated after their diagnosis for a period of no less than 10 days and recieved confirmation from a qualified public heath offical that they are no longer required to isolate.

PART 3:

I/WE acknowledge and agree that:

G. In the event that during the next 14 days. I/WE should experience any of the symptons as set out in 2(d). or learn of any circumstances that would change my response to any of the above questions. I/WE will immediately inform the builder or agent.

H. I am/WE are aware of the inherent health risks and concerns related to my attendance at the property, and with any contact I may habe with those involved. I am allowing or particpating in the viewing of the property of my own free will and accord. I will not hold the Builder or nay of their representatives responsible for any claims, costs, damages, expenses or liability related to any adverse heath-related consequences arising as a result of allowing or having access to the property for the purpose of viewing it.

I. The information contained in this declaration may be retained by the Parade Builder for a period of up to eight weeks. In the event the Parade Builder considers it necessary for public health purposes to release this declaration or any information contained herein to any health authorities or anyone else, they may do so.