International Student
Quarantine Plan
Last updated: January 7, 2021
Personal Information
Name (first, last): ____________________________________ Country of Origin: ________________________________
Passport Number: __________________________________ Home Address: __________________________________
Date of Birth (yyyy/mm/dd): __________________________
Arrival Information
Arrival Date: ________________________________________ Port of Entry into Canada: ________________________
Arrival From: _______________________________________ Arrival By (airline name, flight #): ____________________
Quarantine Plan
Quarantine site (name and address of homestay, hotel or accommodation provider):
___________________________________________________________________________________________________________
I confirm that the following are provided by my quarantine site:
Transportation to quarantine site 3 meals/day delivered to my room
Access to needed toiletries, linen, cleaning supplies, etc.
I confirm that I will not be living with vulnerable persons or in shared accommodation during the
period of mandatory quarantine upon entry.
I confirm that I am entering Canada with medical insurance that provides coverage for COVID-19
during the period of mandatory quarantine upon entry.
I confirm that I have access to sufficient funds to cover any and all additional COVID-19-related
costs, including testing if required.
Commitment to this Plan
I, [STUDENT NAME] ______________________________________, confirm that I understand the importance
of the quarantine procedure upon arrival in Canada, and will follow all criteria provided in this
document, as well as all requirements provided by the Government of Canada, for a full 14 days.
Signature: __________________________________________ Date: _____________________________________________
