Quarantine or Self Isolation Plan - Upper Grand - International Student Program

Student Name (In English) *

First

Last

Date of birth (YY/MM/DD) *

Student Phone Number *

Student Email *

Home Address (Including City, Province or Territory and Postal Code) *

Primary Contact Name *

First

Last

Primary Contact Date of birth (YY/MM/DD) *

Primary Contact Phone Number *

Relationship (homestay/family/relative) *

Primary Contact Email *

Primary Contact Address (Including City, Province or Territory and Postal Code) (copy) *

Are there additional travelers in your group? *

Yes
No

If yes, please provide additional travelers First Name, Last Name and Date of Birth (YY/MM/DD)

Arrival Date (YY/MM/DD) *

Arrival From (City/Country) *

Arrival by *

Air
Sea
Ground

Airline / Flight number (if applicable)

What accommodation arrangements have you made for your self-isolation period?

Private Residence (Family or Friend)
Homestay Company

If NOT using a Homestay Company, this SPA Non-Homestay Participant Nov 2020.pdf needs to be completed and emailed to International.student@ugdsb.on.ca

In which city will you be completing the 14 day quarantine / self-isolation period?

I Understand that as part of the Quarantine Plan at private accommodations & expectations during the 14-day Quarantine, families will ensure the following conditions for their students (and student family unit) during the 14-day Quarantine period: *

I Understand that as part of the Quarantine Plan at private accommodations & expectations during the 14-day Quarantine, families will ensure the following conditions for their students (and student family unit) during the 14-day Quarantine period:

     • Provide designated household items such as laundry basket, dishes, drinking glasses, eating utensils, etc.
     • Provide instructions on how to access the household internet
     • Designate a bathroom for student use
     • Provide laundry instructions and supplies for the student
     • Windows can be opened to allow for more air circulation in the house
     • Provide cleaning and disinfectant supplies for students use
     • Provide 3 meals a day
     • Provide access to internet services

Confirm that I have arranged private transportation (copy) *

Confirm that I have arranged private transportation

Confirm that I have downloaded the ArriveCan app and it is being used as per Canadian Government requirements *

Confirm that I have downloaded the ArriveCan app and it is being used as per Canadian Government requirements

I certify all of the information to be accurate. *

I certify all of the information to be accurate.