Saudi Arabian Cultural Bureau in Canada.

Covid-19 Consent form

Due to the COVID-19 Pandemic, we have instituted an additional consent form. Please submit the form prior to arrival.

If you are able to wear a mask to your appointment, please do so. Otherwise, we will provide you with one upon entry into the Saudi Arabian Cultural Bureau.

First Name

Last Name

Visitor Email

Visitor Mobile

Are you currently a Visitor registered to Safeer2?

I understand the novel coronavirus causes the disease known as COVID-19. I understand the novel coronavirus virus has a long incubation period during which carriers of the virus may not show symptoms and still be contagious.

I Confirm

Are you presenting any of the following symptoms of COVID-19 identified by Public Health Services?

Fever over 38°C

Cough (new or worsening chronic)

Sore Throat

Shortness of Breath

Difficulty Breathing

Flu-like symptoms

Nausea / vomiting, diarrhea, abdominal cramps (or unknown origin)

Conjunctivitis (Pink Eye)

Decrease of loss of sense of taste or smell

Chills

Headaches

Unexplained Fatigue / Malaise / Muscle Aches

Runny nose / nasal congestion without other known cause

Have you tested positive for COVID-19 OR had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?

Are you waiting for the results of a laboratory test for the novel coronavirus?

Have you returned to Ontario from any country outside of Canada whether by car, air, bus or train in the past 14 days?

In the last 14 days, have you been identified as a contact of someone who has tested positive for novel coronavirus or been asked to self-isolate by Public Health, the Communicable Disease Control or any other governmental health agency.

I understand that any travel from any country outside of Canada, including travel by car, air, bus or train, significantly increases my risk of contracting and transmitting the novel coronavirus. Public Health requires self-isolation for 14 days from the date a person has returned to Canada.

I Confirm

I understand that Public Health has asked individuals to maintain physical distancing of at least 2 meters (6 feet) *

I Confirm

I verify the information I have provided on this form is truthful and accurate.

I Confirm