Hello everyone,

On Thursday November 4th 2021 Lakeshore Waves will be restarting at the Masonic Hall in Port Hope from 7 - 9 p.m. We will be operating with a limit of 35 people only, so if you would like to come, please pre-register by sending me an email to let me know. You will be accepted on a first to reply basis so be sure to let me know asap. Please find attached and read the safety plan. You must provide proof of vaccination. Please arrive by 6:45 to complete the paperwork etc. 

Our caller will be Rick Gerris until Wayne Whatman feels up to coming back. We will start slowly with basic dancing to ease everyone back into it and see how we go from there.

Lakeshore Waves Safety Plan

  1. Dancers will wear masks at all times. Caller will wear mask when walking on the dance floor. Mask can be removed on stage to assist dancers who need to hear the directions given by the caller. Masks can be changed between tips at dancer discretion.


  2. While not dancing, a physical distance of 2 meters will be maintained as much as possible. Chairs will be set around perimeter of room with appropriate physical distancing.

  3. All dancers will sanitize hands between tips. Sanitizer will be at available throughout the hall (i.e either side of the stage and at registration tables).

  4. Dancers will bring own beverage and refreshment. Food will not be shared between dancers.


  5. Dance floor will be held to 4 squares max + caller. A pre reservation will be initiated if club has more than this number of individuals in attendance.

  6. Contact tracing will be completed on a weekly basis. Dancers will enter name and phone number.

  7. Dancers will be screened for vaccination status and photo ID. Double vaccination will be strictly enforced. Status will be recorded and confirmed on first dance night.

  8. Covid screening questions will be asked on a weekly basis. Individuals can be asked orally with response and negative result recorded or dancers can complete paper copy on day of dance.

  9. Dancers are made aware of Code of Conduct and Liability Waver and will sign agreement to these procedures.

  10. One person will be assigned to the door to ensure that everyone who enters is masked and maintains 2 meter distance while in line.

  11. Order of procedures:

  a.Record name and phone number for tracing purposes

  b. Proof of vaccination and photo ID for those new to event (First night only). Will continue if new dancers arrive after first night. Signing of code of conduct

  c. Proof of Pre Screen question done weekly.

  d. Payment of dues for evening. Treasurer will include phone numbers, address, and email address upon registration of dancer.

Lakeshore Waves COVID19 Code of Conduct and Release


First Name Last Name

Email _____________________________________________


Phone Number _________________________________ Date ____________________


Code of Conduct

Masks, which cover the nose, mouth, and chin, are mandatory, Full vaccination of all dancers and callers, by two weeks; proof of vaccination shown at door, COVID screening (symptom check) upon arrival, Hand washing or hand sanitizing after every tip, Physical distancing as much as possible, No hugging or physical contact beyond regular dancing, Respiratory etiquette (cough or sneeze into arm), Cleaning and maintaining healthy facilities, Doors and windows open for high ventilation, if possible. Bring your name badge and own water bottle, No undocumented visitors, Contact tracing in combination with isolation and quarantine, in collaboration with the public health department, as needed


Release of Liability, Waiver of all Possible Claims, and Assumption of Risk

I hereby acknowledge that I have agreed to attend and use the facilities of the Port Hope Masonic Temple (the “Club”) in the Province of Ontario. I also acknowledge and accept that while attending the Club, I may, at times, be closer than the recommended social distancing guidelines due to the nature of the activity I am participating in. I acknowledge and confirm that I am willing to accept this risk as a condition of attending a Lakeshore Waves Club event. In consideration of the use of the Club facilities, I agree to release the Club (if applicable), their officers, directors, agents and volunteers (the “Releasees”) from any and all causes of action, claims, demands, requests, damages or any recourse whatsoever in respect to any personal injuries or other damages which may occur or arise as a result of exposure to COVID-19 during my visit to the Club and/or through the provision of services to me by the Club. I do hereby acknowledge and agree that notwithstanding the generality of the foregoing, I declare that I will not commence litigation or otherwise seek to recover damages or other compensation against the Releasees based on any action, claim, demand, request, loss or any recourse whatsoever arising from any potential or actual exposure to COVID-19 while attending the Club event and/or through the provision of services to me by the Club. I further acknowledge that the Releasees can rely on this Release of Liability, Waiver of all Possible Claims and Assumption of Risk as a complete defense to any and all claims, damages, causes of action, or recourse or liability that may arise at any time. I have carefully reviewed this Release of Liability, Waiver of all Possible Claims and Assumption of Risk and acknowledge that I fully understand the terms as set out above. I acknowledge that I am signing this Release of Liability, Waiver of all Possible Claims and Assumption of Risk voluntarily.This Release of Liability, Waiver of all Possible Claims and Assumption of Risk may be executed and delivered by fax transmission or by electronic mail transmission in PDF or similar electronic document format, which will constitute complete delivery and a binding agreement.


I agree to Code of Conduct Release of Liability, Waiver of all Possible Claims, and Assumption of Risk





  1. Do you have any of the following NEW OR WORSENING symptoms or signs?

  • Fever or chills                                                                                                    Y   N

  • Difficulty breathing or shortness of breath                                                 Y   N

  • Sore throat; trouble swallowing                                                                     Y   N

  • Runny nose/stuffy nose or nasal congestion   (not related to allergies) Y   N

  • Decrease or loss of smell or taste                                                                 Y   N  

    Have you had close contact with a probable or confirmed                          Y   N

case of COVID -19?


   Are you or any member of you household awaiting results of any COVID -19 testing?    Y   N

If you have answered ‘no’ to all the above questions, you are permitted to join in square dancing.



Name and Signature Date

Lakeshore Waves COVID-19 Screening Questionnaire