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Family Camp at Shomira COVID-19 Screening
Please fill out the following form for every family member that will be joining Camp Shomria this summer
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* Indicates required question
Email
*
Your email
Parent Name (first & last)
*
Your answer
Camper Name (first & last)
*
Your answer
Do you have a valid health insurance
*
yes
No
Has your child experienced any of the following symptoms in the last 24 hours?
*
As advised by DOH, individuals with COVID-related symptoms should stay home and isolate.
Fever
New cough; worsening of chronic cough
Shortness of breath; difficulty breathing
Sore throat
Loss of smell or taste
Chills
Headaches
Unexplained fatigue / muscle aches
Gastrointestinal symptoms: Nausea / Vomiting, Diarrhea, Abdominal Pain
Runny nose or nasal congestion without other known cause
My child have NOT experienced any of these symptoms in the last 24 hours
Does your child have any pre-existing condition and/or illness that may account for Covid-19 symptoms?
*
Yes
No
Maybe
If 'Yes' or 'Maybe, please explain.
Your answer
Has your child traveled abroad or outside of New York / New Jersey / Connecticut in the last 14 days?
*
Yes
No
If yes, where did you travel and when did you arrive in NY
A copy of your responses will be emailed to the address you provided.
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