Self-Isolation Plan

International Student Quarantine Plan
Personal information
Name: *

First Name Last Name
Date of birth: *

Month Day Year
Date
Email: *
example@example.com
Country of origin: *
Phone Number: *

Country Code Phone Number
Passport number: *
Home Address: *

Street Address

City

State / Province Country

Postal / Zip Code
Arrival information
Arrival date: *

Month Day Year
Date
Arrival from: *
Arrival by (airline name and flight #):
Port of entry into Canada: *
Quarantine plan
Quarantine location: *

Hotel Homestay Residence Other
Please provide the address of your quarantine location: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
I confirm that the following are provided by the quarantine site: *

Transportation to quarantine location 3 meals / day, delivered to my room Access to needed toiletries, linen, cleaning supplies etc.
Address in Canada after self-isolation: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
I confirm that: *

I am entering Canada with medical insurance that provides coverage for COVID-19 during the mandatory quarantine upon entry period
Commitment to this plan
I (Student name) blanks* , confirm that I understand the importance of the quarantine procedure upon arrival in Canada, and will follow all criteria provided in this document, as well as all requirements provided by the Government of Canada, for a full 14 days.
Signature: *

Clear
Date: *

Month Day Year
Date
Should be Empty:

International Student Quarantine Plan