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Camper Health Assessment Form
Please complete this form by August 29. Players will only be able to participate in the program upon it's completion.
The form is to be completed for each child in the family. If you respond "Yes" to any statement, your child will not be permitted to participate in the Fall House League program.
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Camper First Name
*
Your answer
Camper Last Name
*
Your answer
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
I, or another a member of my household is currently experiencing symptoms related to COVID-19 (cough, fever, trouble breathing, extreme fatigue, sore throat, sudden loss of taste or smell, purple fingers or toes).
*
Yes
No
I or a member of my household has experienced a cold or flu-like symptoms within the last 14 days.
*
Yes
No
I or a member of my household has had close contact with someone who has been diagnosed with COVID-19 within the last 14 days.
*
Yes
No
I or a member of my household has travelled outside the country within the last 14 days.
*
Yes
No
I or a member of my household has been in close contact with a person who has travelled outside the country within the last 14 days.
*
Yes
No
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