Proof of Vaccination Information Consent Form

From September 13, patrons must have at least one dose of a COVID-19 vaccine, and by October 24, 2021 must be fully vaccinated (two doses) to access certain programs and services at PISE. The requirement applies to all people born in 2009 or earlier (12+). To meet the requirements of the PHO, staff will ask to see your proof of vaccination card and one piece of valid government issued photo identification. Patrons will be required to provide your BC Vaccine Card either digitally or as a paper copy as of September 26, 2021. Until September 26, 2021, patrons may also show the orange and blue COVID 19 Immunization Record paper card received at the time of vaccination. Youth aged 12-18 who are accessing fitness activities or events are only required to show proof of vaccination and not government issued photo ID. Please see the BC Proof of Vaccination website for more information - https://www2.gov.bc.ca/vaccinecard.html

Please be aware that proof of vaccination will be required every time you come to the facility unless you provide written consent for staff to place your information on your ActiveNet profile.  This information will be removed from your account when the order is lifted. To help speed up entry please have your documents ready before you arrive at the fitness centre entrance desk.  Program participants will be required to show their proof to their coaches for their session.

By signing this form, you are providing written consent for PISE to make a note of your proof of vaccination on your personal ActiveNet profile in order to expedite the speed of entry in to the facility. 

Should you like to withdraw this consent at any time, please email info@pise.ca.


Signee Information

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.