YAC Contact Tracing Form

1

If you or anyone in your group is exhibiting COVID-19/flu-like symptoms* or are feeling ill, please stay home. *(including fever, cough, sore throat, respiratory illness, difficulty breathing)

AGREENO (PLEASE STAY HOME)

2

If you or anyone in your group is exhibiting COVID-19/flu-like symptoms or are feeling ill, please do not visit the Yukon Arts Centre.

3

Name* This field is required.This information will be retained confidentially for three-months after submission. This data will only be used in the event to help Yukon authorities trace transmission of COVID-19.

First Name

Last Name

4

E-mail* This field is required.

5

Phone Number

Area Code

Phone Number