Grade 11 ALIVE COVID Attestation Form

Page 1

COVID-19 Attestation School Groups (Overnight) Group/Organization Name (if applicable)

Arrival Date

ALIVE Outdoors & The York School May 9, 2022

Departure Date

Participants (over 18 years)

May 11, 2022

Participants (17 years & under)

I confirm that I have been following all Public Health Guidelines, including limiting contact with individuals outside of my immediate household and school, in the 14 days preceding my arrival at YMCA Camp Pine Crest Outdoor Centre.

I confirm that my child has been following all Public Health Guidelines, including limiting contact with individuals outside of the immediate household and school, in the 14 days preceding their arrival at YMCA Camp Pine Crest Outdoor Centre.

I understand that taking these precautions is a condition of my attendance at YMCA Camp Pine Crest Outdoor Centre.

I understand that taking these precautions is a condition of my child’s attendance at YMCA Camp Pine Crest Outdoor Centre.

I confirm that I am in compliance with all COVID-19 related requirements of my school.

I confirm that my child is in compliance with all COVID-19 related requirements of their school.

I also acknowledge the importance of following screening guidelines and adhering to the YMCA’s check-in recommendations (including physical distancing guidelines) in order to prevent the spread of COVID-19.

I also acknowledge the importance of following screening guidelines and adhering to the YMCA’s check-in recommendations (including physical distancing guidelines) in order to prevent the spread of COVID-19.

YES

NO

Date Participant Name Participant Signature Parent/Guardian Name (if participant is under 18)

Parent/Guardian Signature (if participant is under 18)

YES

NO


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