• White/Black
  • Standard

Current Style: Standard

Instagram Icon   Facebook Icon  Twitter Icon

COVID 19 Group/Individual Rental Screening and Waiver Form

Preserving the health and wellness of our residents and visitors is the Municipality of Dutton Dunwich priority. To prevent the spread of COVID-19, and to reduce the potential risk, we are conducting a simple screening questionnaire that we are asking you to complete and submit prior to entering any municipal facility.  

This checklist is meant to keep everyone health. It is only a basic checklist and not meant to take the place of medical advice, diagnosis or treatment.

NOTE:  If you answered yes to any of these questions DO NOT enter this facility. Thank you!

I hereby release and save harmless the Corporation of the Municipality of Dutton Dunwich and its employees and representatives from any and all claims and demands associated with my, or my child, acquiring Covid-19, from my attendance at Municipality of Dutton Dunwich facilities, due to any cause whatsoever, including breach of contract, mistakes or errors in judgment. This Release of Liability shall be binding upon my heirs, next of kin, executors, administrators, assigns and representatives. I acknowledge Covid-19 has a long incubation period during which carriers of the virus, including those who are full vaccinated, may not show symptoms and still be contagious and that I, or my child, have an elevated risk of contracting Covid-19 by being around other people in a public setting and I hereby assume the risks with respect to acquiring COVID-19 inherent in my, or my child’s, attending Municipality of Dutton Dunwich facilities, including the associated risk of death or severe bodily injury that may accompany Covid-19.
  • Office Hours

  • Monday to Friday,
  • 8:30 am to 4:30 pm
  • (except statutory holidays)