Troop 4045 COVID-19 Pre-Screening Questionnaire and Consent Acknowledgement for In-Person Activities
This form must be submitted for each Troop activity.  Parents/guardians should be filling this out on behalf of their scouts, as well as themselves if they are attending the event.  YOU MUST CONFIRM THAT THE ANSWERS BELOW ARE TRUE IN ORDER TO PARTICIPATE IN THIS EVENT.

COVID-19 is an extremely contagious virus that can spread through person-to-person contact.  As with any social activity, participation in in-person Scouting activities could present the risk of contracting COVID-19. While Troop 4045 will take numerous safety and preventative precautions, we and the BSA can in no way warrant that a COVID-19 infection will not occur through participation in such programs or troop activities.

Those who have serious underlying medical conditions or are at higher risk for severe illness from COVID-19 are recommended to stay at home. Individuals and families should consult their healthcare provider to determine whether they have medical conditions that place them at risk. In accordance with CDC and NYS Department of Health Guidelines and the BSA, Troop 4045 has developed the following health pre-screening questionnaire. It is mandatory that you (if 18 or over), a parent or legal guardian complete this assessment no more than 60 minutes before each scout activity. ALL PARTICIPANTS (scout, leader or non-scout) must be represented on a form. You will not be able to participate unless this form is complete and submitted.
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First and Last Name (of person submitting) *
Who are you checking in (include first names of others that are attending the event under 'Other')? *
Required
In the past 24 hours, none of the individuals attending this event have had a fever greater than 100.0 degrees F, or are exhibiting any abnormal or unexpected COVID-19 symptoms, including fever, chills, sweating, cough, shortness of breath, muscle or body aches, loss of taste or smell, sore throat, nausea, vomiting, diarrhea, headache, fatigue, or congestion. *
Required
All individuals attending this event are in compliance with NYS travel restrictions (https://coronavirus.health.ny.gov/covid-19-travel-advisory). *
Required
None of the individuals attending this event have been  knowingly in close contact in the past 10 days with anyone who has tested positive for COVID-19, have themselves tested positive, or are currently in isolation or quarantine per the NYS Department of Health. *
Required
I have received and understand the Troop 4045 COVID-19 RESTART PLAN (https://drive.google.com/file/d/1vb5VafdtSRuuvHp5vw1PcfR45XnyTRtA/view?usp=sharing). If signing as a Parent or Guardian for a child under 18, I will discuss proper social distancing behaviors in a group setting with my child prior to attending and in-person activities.  Checking this box indicates that I have read and understand the PRE-SCREENING QUESTIONNAIRE AND CONSENT ACKNOWLEDGEMENT. *
Required
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