Rockaway Township Summer Playground Program COVID-19 Screening Form

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Parents of campers are asked to fill out this form each day in order to prevent the spread of COVID-19 at Rockaway Township's Summer Playground Program

Email *

Name of Camper *

Name of Parent *

Has your child had a temperature of 100.4 or higher within the past 3 days? *

Yes

Has your camper had any of the following symptoms within the past 3 days?

Gastric distress (Vomiting -or- Diarrhea)

Nausea

Cough (unrelated to allergies)

Unusual Muscle Pain

Sore throat (unrelated to allergies)

Shortness of Breath

Loss of sense of taste or smell

Unusual Fatigue

Worsening/Consistent Headaches

In the past 14 days has your camper been in close contact with any person who has tested positive for COVID-19? *

Yes

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