COVID Screening - Cub Scout Pack 306

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Please complete this form for every scout meeting or event. Please recognize that there are risks associated with any gathering. By attending a scouting event, you indicate that you fully understand the risks including possible exposure to COVID-19, you also indicate that you are not currently ill or showing symptoms of COVID-19, and you will not hold Pack 306, the NNJ Council or BSA liable for illness or COVID exposure.

Please wear a mask and stay a safe 6-foot distance from people who are not members of your household.

All form fields are required. IF YOU ANSWER YES TO ANY OF THE QUESTIONS BELOW, DO NOT ATTEND this scouting event.

Scout Name *

Scout Den *

Today's Meeting / Event Location *

Have you, your scout, or any member of your home experienced any of these symptoms in the past 48 hours? • fever or chills • cough • shortness of breath or difficulty breathing • fatigue • muscle or body aches • headache • new loss of taste or smell • sore throat • congestion or runny nose • nausea or vomiting • diarrhea *

YES (if yes do not attend)

Within the past 14 days, have you, your scout, or any member of your home been in close physical contact (6 feet or closer for at least 10 minutes) with a person who is known to have laboratory-confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19? *

Yes (if yes do not attend)

Are you or your scout or any member of your home isolating or quarantining because you may have been exposed to a person with COVID-19? *

Yes (if yes do not attend)

Are you or your scout or any member of your home currently awaiting the results of a COVID-19 test... or have you received a positive COVID-19 test? *

Yes (if yes do not attend)

Are you or your scout or any member of your home worried that you/they may be sick with COVID-19?

Yes (if yes do not attend)

Clear selection

Within the last 14 days, have you, your scout, or any member of your home traveled to/from any state on the NJ travel advisory list? *

Yes (if yes do not attend)

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