Form Builder

Required fields are marked with asterisks (*)

COVID-19 Contractor or Visitor Screening Questionnaire and Release of Liability Declaration  V8 October 2021

Due to the recent outbreaks of COVID-19 across the globe and in our efforts to protect our employees and limit the spread of the virus, the Town of Gravenhurst requires you to complete this form prior to attending any of our facilities, even if you have been vaccinated.  Preferred payment for services is by credit card or cheque.

Screening Questions to determine your status

Please answer the following questions.

Completion of this declaration is mandatory.  Failure to provide information will prevent you from entering or visiting the facility.  Please complete your details to confirm you have read and understand this declaration.  

If it is determined that you deliberately or negligently provided false answers to the above noted questions, you may be barred from entering any Town facility in the future.

Declaration

  1. I acknowledge COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious and that I have an elevated risk of contracting COVID-19 by being around other people in a public setting, and I hereby assume the risks with respect to acquiring COVID-19 inherent in participating in work, or participating in activities and programs at a Town of Gravenhurst site(s), including the associated risk of death or severe bodily injury that may accompany COVID-19.
  2. I hereby release and save harmless The Corporation of the Town of Gravenhurst and its employees and representatives from any and all claims and demands associated with my acquiring COVID-19, from working at or visiting a Town of Gravenhurst site, due to any cause whatsoever, including negligence, breach of contract, mistakes or errors in judgment. This Release of Liability shall be binding upon my heirs, next of kin, executors, administrators, assigns and representatives.
Clear

When you arrive at the facility:

You will be required to wear a face mask or face covering and sanitize your hands when you enter.  Please note that public washrooms are currently closed at our facilities.



Contact Us