Visiting MPL Branches Visitor Information Form Please complete this form to enter the branch. * indicates a required field Email address: * Required Phone number:Your full Legal Name * Required First Middle Last Markham Public Library Card NumberWhich branch are you visiting today: * RequiredAaniin LibraryAngus Glen LibraryMarkham Village LibraryThornhill Community Centre LibraryDo you have any of the 4 following symptoms? * RequiredDo you have any of the 4 following symptoms? * 1) Fever (feeling hot to the touch, temperature of 37.8 celsius degrees or higher); 2) A squeaky or whistling noise when breathing (croup); 3) Cough that's new or worsening (continuous, more than usual), barking cough; 4) Difficulty breathing, shortness of breath (out of breath, unable to breathe deeply) YesNoAre you experiencing any of the following otherwise unexplained symptoms? * RequiredMuscle ache, fatigue, headache, sore throat, hoarse voice (more rough or harsh than normal), difficulty swallowing, stuffy, congested or runny nose, chills, lost sense of taste/smell, digestive issues(nausea/vomiting, diarrhea, stomach pain), fatigue(lack of energy, extreme tiredness), falling down more than usual. Yes No Have you had close contact with someone who has, or is suspected of having, COVID-19? * Required Yes No Have you travelled outside of Canada in the past 14 days? * Required Yes No Have I had close contact with someone who has travelled internationally and has a fever and/or cough and/or difficulty breathing? * Required Yes No Send me a copy of my responses. NameThis field is for validation purposes and should be left unchanged. Close How is the information I enter in this webform being protected? Any information you send using this webform is protected in transit with SSL encryption.Visit our Privacy Statement, opens in a new window to learn more about how your personal information is handled and protected. Information submitted in this webform is secure. Learn More about sending data over email.