Wyldlife May 21 Sign Up For In Person

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

7pm Canby Alliance Church 900 N Juniper St

First Name *

Last Name *

Parent Email *

Grade *

6th grade

7th grade

8th grade

School *

Emergency Contact *

Phone Number *

Have you experienced any of the following symptoms in the past 48 hours: fever/chills, cough, shortness of breath/difficulty breathing, fatigue, muscle/body aches, headache, new loss of taste or smell, sore throat, congestion/runny nose, nausea/vomiting, or diarrhea? *

Yes

Within the past 14 days, have you been in close physical contact (6 feet or closer for at least 15 minutes) with a person who is known to have confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19? *

Yes

Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19? *

Yes

Are you currently waiting on the results of a COVID-19 test? *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms