COVID-19 Prescreening Questionnaire ({{gravity-field-id-3}})

The health and safety of Lone Prairie Camp's campers, rental guests and staff is our top priority and we are committed to heeding current provincial and federal government recommendations. As part of those measures, we appreciate you taking the time to complete this COVID-19 Prescreening Questionnaire and encourage you to review the information available at the above links.
  1. The Alberta Health Services COVID-19 SELF-ASSESSMENT ( has been completed today () for and any additional guests in their group () and the answer to all the Self-Assessment questions was a truthful "No". Furthermore, the Alberta Health Services COVID-19 SELF-ASSESSMENT did not recommend self-quarentine nor COVID-19 testing.
  2. I have read the Alberta Government's recommendations regarding carpooling and masks.

It is important that this document is signed by the participant (or their parent/guardian if the participant is under 18 years old) on the day of arrival. Please complete the Alberta Health Services COVID-19 SELF-ASSESSMENT and digitally sign this document before arrival but not before the day of arrival.

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Signature Certificate
Document name: COVID-19 Prescreening Questionnaire ({{gravity-field-id-3}})
lock iconUnique Document ID: 799f2daa4a578414dd9c1863f502892fa9e83162
Timestamp Audit
June 19, 2020 6:33 pm MDTCOVID-19 Prescreening Questionnaire ({{gravity-field-id-3}}) Uploaded by LPC Registrar - IP
June 19, 2020 6:46 pm MDT Document owner has handed over this document to 2020-06-19 18:46:29 -