Registration Day Health Screening

This health screening form must be filled out before attending registration day at Vancouver Start Smart Preschool.

It must be completed on the day of  registration, prior to arrival at the preschool by the person who is registering a child–whether parent, alternate caregiver, or family proxy.   Please answer on behalf of yourself and the family or people you have been most recently in contact with!  


You will not be allowed to enter preschool if you have not completed the form on registration day  at preschool.  There will be no exceptions.


What is your first and last name?

What is the registering child's first and last name?

(Note: Parents : Child name only. Proxy or alternate dropoff: please indicate your relationship to the family/child followed by the child's name
(i.e. Grandparent/Child name, nanny/child name)

In the last 48 hours, have you or any of your immediate family, or participants in their social bubble:

  1. Had a fever, cough, sore throat, runny nose, or shortness of breath?
  2. Felt unwell?
  3. Been in close contact with someone who is sick?
  4. Been in close contact with someone who has confirmed Covid-19 in the past 14 days?
  5. Travelled outside of Canada in the past 14 days?

YesNo


If you have answered YES above, please do not come to the preschool. If the answer is NO, we’ll see you in class!

Please DO submit the form in either case so that we can notify other families if necessary. Contact your health care provider for further guidance.

Our community’s safety relies on your honesty. Thank you for helping to keep us all safe.