COVID-19 Show Home Pre-Screening Declaration Form Fall 2020 Parade of Homes Please enable JavaScript in your browser to complete this form.Part 1This declaration is made in connection with my/our attendance at the property commonly known as: *Date of visitation: *Part 2I confirm the following statements to be true (check all that apply):a. I/WE have not been diagnosed with a lab-confirmed probable or positive case of the COVID- 19 virus.b. In the last 14 days I/WE have not travelled outside of Manitoba unless such travel was only within a western Canadian jurisdiction designated under Phase 3 of the Manitoba Restoring Safe Services Plan (British Columbia, Alberta, Saskatchewan, Northwest Territories, Yukon, Nunavut, or west of Terrace Bay in Northwestern Ontario).c. I/WE have not knowingly been in contact with anyone who travelled into Manitoba in the last 14 days from another jurisdiction unless such travel was only within a western Canadian jurisdiction designated under Phase 3 of the Manitoba Restoring Safe Services Plan (British Columbia, Alberta, Saskatchewan, Northwest Territories, Yukon, Nunavut or west of Terrace Bay in Northwestern Ontario).d. I/WE have not experienced any of the following symptoms in the last 14 days: fever, dry cough, loss of sense of taste, loss of sense of smell, shortness of breath, or difficulty breathing.e. I/WE have not knowingly come into contact with anyone experiencing any of the following symptoms in the last 14 days: fever, dry cough, loss of sense of taste, loss of sense of smell, shortness of breath, or difficulty breathing.f. I/WE have not knowingly come into contact with anyone in the last 14 days who has been diagnosed with a lab-confirmed probable or positive case of the COVID-19 virus.Part 3I acknowledge and agree that:a. In the event that during the next 14 days I/WE experience any of the symptoms stated in Part 2 d. (fever, dry cough, loss of sense of taste, loss of sense of smell, shortness of breath, or difficulty breathing), or learn of any circumstances that would change my response to any of the above questions I/WE will immediately inform the builder or agent.b. I am/WE aware of the inherent health risks and concerns related to my/our attendance at the property. I am/WE are participating in the viewing of the property of my/our own free will and accord. I/WE will not hold anyone responsible in the event I/WE contact the COVID-19 virus as a result of my attendance at this property.c. The information contained in this declaration may be retained by the Builder for a period of up to eight weeks. In the event the Builder considers it necessary for public health purposes to release this declaration or any information contained herein to any health authorities or anyone else, they may do so.To the best of my knowledge everything contained herein is true, and this declaration may be relied upon as having the same force and effect as if made under oath.Name of Declarant *(on behalf of their party)Phone *Can we contact you for sales and marketing questions *YesNoSubmit
