Speranza Banquet Hall

Speranza Hall will require all guests to be screened upon arrival. Each guest must answer all COVID-19 questions that also contain their contact information to ensure we are meeting government regulations. Any guests unwilling to do so will be denied our Facility Entry (this includes names, number etc. information and date of visit). This will help support case and contact tracing in the event of an outbreak. This completed form must be shown to the personnel representing of Speranza Hall prior to entering the Facility

Please note, you are only allowed to enter other family members if they live in the same household and have the same physical address. Otherwise, 2 separate forms will have to be submitted.

Name:

Telephone:

Address:

Date of Visit:

E-mail:

Family Members1:

Family Members2:

Family Members3:

Family Members4:

Family Members5:

Family Members6:

COVID-19 Questionnaire:

1. Have you or any family members listed above recently returned from a cruise within the last 14 days? Yes No

2. Have you or any family members listed above travelled outside of Canada or been in contact with anyone who has travelled outside of Canada in the last 14 days? Yes No

3. Have you or any family members listed above been in contact with someone diagnosed with COVID-19 in the last 14 days? Yes No

4. Do you or any of the family members listed above have any of the following Flu like symptoms?
Fever Yes No

Cough Yes No

Shortness of Breath Yes No

5. Do you and the above-mentioned family members agree to social distance yourself from others and maintain a distance of at least 2 metres from anyone on site? Yes No

I declare that the answers provided to the questions on this online report are true to the best of my knowledge.

I understand this information will be used to determine my eligibility for entering the venue.

I understand the information I have provided is subject to verification and that giving false information for myself or someone other than myself constitutes fraud. I also understand there are penalties for knowingly making false statements.

Please note that by filling out this report, you will be deemed to have signed your online report.

Covid Check-In

COVID-19 Questionnaire: