The health and well–being of our Place des Arts (PdA) community is our priority. We are taking measures to keep PdA a safe environment for all.

Therefore, all volunteers aged 18 years and up, and the parents/guardians of volunteers under the age of 18 years, must complete a COVID-19 Volunteer Health Declaration (VHD) webform on the morning of, or up to 30 minutes before the volunteer will enter the PdA building, or any authorized satellite site hosting PdA programs (“Facilities”), to perform work.

The screening questionnaire is used to identify volunteers:

who may be experiencing COVID-19 symptoms, as characterized most recently by federal and provincial public health officials;
who have knowingly come into close contact with anyone who has tested positive for COVID-19 or who has been ordered to self-isolate (including a member of their household); and/or
who have travelled outside of Canada.

A volunteer who answers “yes” to any questions on the VHD, or who experiences any of the listed symptoms after completing the VHD, should not enter the PdA facility. Please contact the PdA registration desk (604 664 1636 ext. 0) as soon as possible.

Volunteer Health Declaration Form

Volunteer First Name *

Volunteer Last Name *

Parent/Guardian First Name

Required for volunteers under 19.

Parent/Guardian Last Name

Phone # *

Email *

Volunteer Position *

1. Do you or does anyone in your household have any of the following symptoms, either new or worsened (if not associated with allergies, chronic or pre-existing conditions): *

fever, chills, fatigue, sneezing, cough, shortness of breath, difficulty breathing, sore throat, headache, loss of taste and smell, muscle aches and/or runny nose?

Yes

2. Have you come into close contact with someone who has tested positive for COVID-19 or who has been ordered to self-isolate in the past 14 days? *

Yes

3. Have you or has anyone in your household returned from travel outside of Canada (including USA) in the past 14 days? *

Yes

If you answered “yes” to any of these questions, or experience any of those symptoms after completing this form, contact the PdA registration desk ASAP (604 664 1636 ext. 0).

Please confirm each of the following: *

I certify that I answered the questionnaire truthfully and to the best of my knowledge or my child’s current health status

I acknowledge that Place des Arts follows the appropriate protocols to promote safety and health in their Facilities during the COVID-19 pandemic.

I certify that I am aware of the continually updated information provided by the BC Centre for Disease Control on how to protect myself, my family, and my community and what to do if I suspect that I have COVID-19.

Thank you for your co-operation in keeping PdA a safe space.

Please check your email for the confirmation to show at the Check-In Desk at Place des Arts (PdA) or to the PdA supervisor/teacher at any authorized satellite site hosting PdA programs.

Note: If the confirmation email does not show up in your email account be sure to check the junk/spam folder.

COVID-19 Volunteer Health Declaration Form

Volunteer Health Declaration Form