Brainy Camps Pre Camp COVID Health Screening

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All campers, staff and volunteers must fill out this screening form daily 10 days prior to camp arrival.

Full Name of Camper, Staff or Family Member *

Are you experiencing any COVID-19 symptoms which are new or not typical for you? As identified by the CDC, possible COVID-19 symptoms include fever or chills (>100.4F), cough, shortness of breath or difficulty breathing, loss of sense of smell or taste, fatigue, muscle or body aches, headache, sore throat, congestion or runny nose, nausea or vomiting, and/or diarrhea. *

YES

Have you been in close contact with anyone who has tested positive for COVID-19? Close contact is defined as someone who was within 6 feet of a person with known COVID-19 (without proper PPE) for a sum total of 15 minutes or more over a 24 hour period. *

YES

Any additional information:

Submit

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