Legacies Summer Camp COVID-19 Daily Screening Questionnaire

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Below are screening questions for possible COVID-19 symptoms. If you should answer YES to any of the questions below you will not be permitted to be on the VHS campus.

You must complete a separate screener for each of your children participating in the Legacies Camp/Workshop.

Parent's Email Address *

Participant's Last Name *

Participant's First Name *

Participant's Grade Level *

Today's Date *

YYYY

Does your child have a water bottle, lunch and snack? *

Yes

Enter the name of the person who will be picking up your child from camp today. *

If you answer YES to any of the following questions your child will not be permitted to be on the VHS campus. Camp participants must answer NO to be allowed on campus.

1. Has your child recently had any contact with anyone that is/has tested positive for COVID-19? *

Yes

2. Does your child have a new or worsening cough or shortness of breath/difficulty breathing? *

Yes

3. Does your child currently have a fever? (subjective or greater than 100 degrees F) *

Yes

4. Does your child have two or more of the following: chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell or diarrhea? *

Yes

I understand by choosing to allow my child to participate in extracurricular activities which do not allow social distancing or masking increases the risk of COVID-19 transmission to the student and the household. A child who participates in extracurricular activities in which physical distancing cannot be maintained or masking is not practical or possible should practice physical distancing and wear a mask while at home to protect family members. [Please enter parent name below.] *

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