Quiring Chamber Music Camp Daily Participant Screening Form

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You are required to fill out our Daily Participant Screening Form every day with regards to your child’s health and submit it online at the beginning of the day, prior to their arrival at camp, before your child is permitted to participate in the camp activities.

Parent/Guardian Last Name, First Name *

By entering my name and submitting the contents of this form, I certify that my answers are true to the best of my knowledge and in good faith.

Camp Day (Date) *

YYYY

Camp Participant Last Name, First Name *

In the past 24 hours, has your child experienced the following cold, flu or COVID-19 like symptoms: *

Fever higher than 38°C

Chills

Cough

Loss of sense of smell or taste

Difficulty Breathing

Sore Throat

Loss of appetite

Extreme fatigue or tiredness

Headache

Body aches

Nausea or vomiting

Diarrhea

NONE OF THE ABOVE

Required

If you answered YES to ANY symptoms above:

If you answered YES to any symptoms above, your child will not be permitted to attend camp.
Please self-isolate at home, and contact your doctor or primary care provider for further instructions.

If you answered NO to ALL of the above, please complete the next part of the form.

In the past 14 days, has your child... *

Travelled to any countries outside of Canada (including the United States)

Had close contact with a person diagnosed with COVID-19

Had close contact with a person under investigation for COVID-19

Been instructed to self isolate by a doctor, nurse or public health official

NONE OF THE ABOVE

Required

If you answered YES to ANY of the above:

If you answered YES to any of the above, your child will not be permitted to attend rehearsals until cleared by a public health official.

If you have answered NO to ALL of the above, have a great day at camp!

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