Health Screening and Waiver

This health waiver must be signed daily by all participants involved in the therapeutic program, equestrian care professionals, or any other authorized visitors.
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1.     I understand the risks of coming into contact with other people at LTRA, and accept that I could become infected with Covid-19 through exposure at the facility. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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2.     I agree that I will not come to LTRA if I or anyone in my household has had contact of any kind with someone exposed to, or diagnosed with (confirmed or presumptive), Covid-19 in the previous 14 days. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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3.     I agree that I will not come to LTRA if I have any of the following symptoms which are new, or worsened if associated with allergies, chronic or pre-existing conditions:  fever, cough, shortness of breath, difficulty breathing, sore throat, and/or runny nose. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please Note:  If any of these symptoms, or others not noted above, become new or changed from your usual symptoms, then you should stay home and minimize contact with others until you are feeling better.  Complete the AHS Self-Assessment Tool to determine your need for Covid -19 testing.

4.     I agree that if I have returned to Canada from outside the country (including USA) in the past 14 days I will not come to LTRA. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Privacy Policy

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Health Screening and Waiver

Health Screening and Waiver

This health waiver must be signed daily by all participants involved in the therapeutic program, equestrian care professionals, or any other authorized visitors.
     I would like to complete and submit this health questionnaire {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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1.     I understand the risks of coming into contact with other people at LTRA, and accept that I could become infected with Covid-19 through exposure at the facility. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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2.     I agree that I will not come to LTRA if I or anyone in my household has had contact of any kind with someone exposed to, or diagnosed with (confirmed or presumptive), Covid-19 in the previous 14 days. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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3.     I agree that I will not come to LTRA if I have any of the following symptoms which are new, or worsened if associated with allergies, chronic or pre-existing conditions:  fever, cough, shortness of breath, difficulty breathing, sore throat, and/or runny nose. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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4.     I agree that if I have returned to Canada from outside the country (including USA) in the past 14 days I will not come to LTRA. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Privacy Policy

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