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Animal Adoptions of Flamborough
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Potential Animal Surrender Form
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Last
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I agree to answer the following questions based on symptoms that are not related to a chronic condition or related to other known causes or conditions
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No
Symptoms must not be new or worsening.
1 (a) Fever. cough, difficulty breathing or shortness of breath, sore throat, trouble swallowing
Yes
No
1. (b) Runny nose/stuffy nose or nasal congestion, decrease or loss of smell or taste
Yes
No
1. (c) Nausea, vomiting,diarrhea, abdominal pain
Yes
No
1 (d) Not feeling well, extreme tiredness, sore muscles
Yes
No
2. (a) Have you travelled outside of Canada in the last 14 days?
Yes
No
2 (b) Have you had close contact with a confirmed or probable case of COVID-19?
Yes
No
3. Have you had a negative COVID TEST in the last 14 days?
Yes
No
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