COVID Self-Declaration COVID-19 Self-DeclarationPhone: 604-762-8834Address: #800 15355 24 Avenue, Surrey BC V4A 2H9 First Name(Required) Last Name(Required) Email(Required) Phone(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code Do you have any of the following symptoms?Fever(Required) Yes No Cough(Required) Yes No Shortness of breath(Required) Yes No Sore throat(Required) Yes No Runny nose(Required) Yes No Feeling unwell(Required) Yes No Have you had close contact with anyone with respiratory illness or a confirmed or probable/suspected case of COVID-19?(Required) Yes No Have you travelled or had close contact with anyone who has travelled in the last 14 days?(Required) Yes No I certify that the information provided here is true(Required) I certify that the information provided here is true(Required)Signature Reset signature Signature locked. Reset to sign again Δ This waives Archstone & or (sub) contractor(s) from any liability.