Kala Youth Programs: Participant Health Screening
Dear Parents/Guardians:
To keep our participants safe, please makes sure you submit this form and/or review each day your child attends our program. Note that the temperature should be taken at home prior to arrival, and that Kala will do another temperature check and  a visual check once the student arrives. We require parents to inform Kala with about any COVID-19 cases in your child's school/classroom that may impact their participation in our after school program.  

If you're unsure whether to answer "yes" to Symptom questions, please focus on whether the symptom is NEW and/or DIFFERENT from the child’s usual illness, or if the symptoms are UNEXPLAINED. We encourage the parent to trust their intuition.

Please contact Gisela Insuaste, Education & Public Programs Manager with any specific questions or concerns at gisela@kala.org.

The health screening has three parts:  

Exposure Check
Symptom Check & Visual Check
Temperature Check

*You have been in close contact if you have: (a) been within 6 feet of someone who has COVID-19 for a combined total of 15 minutes or more over a 24 hour period or (b)  provided care at home to someone who is sick with COVID-19 or (c) had direct physical contact (hugged or kissed) with someone who has COVID-19 or (d) shared eating or drinking utensils with someone who has COVID-19 or (e) been sneezed on or coughed on by someone who has COVID-19.
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Today's Date *
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Kala Youth Arts Programs *
Required
Participant Name *
Parent/Guardian Email *
Parent/Guardian Phone Number *
(1) In the past 10 days, was the student sent home sick or absent due to illness?   *
(2) In the past 10 days, was the student diagnosed with COVID-19 or did the student have a test confirming that they had the virus? *
If the answer to either question (1) or (2) is YES, make sure the student meets the required criteria for returning to the program.
(3) Within the past 14 days, has the student had close contact* with anyone in the household who was diagnosed with COVID-19 or who had a test confirming they have the virus? *
(4) Within the last 14 days, has the student had close contact* with someone outside the household who was diagnosed with COVID-19 or who had a test confirming they have the virus? *
IF YES to Question 3 or 4 → Student CANNOT attend the program. IF NO to Questions 3 & 4 → Answer Below Questions
Does the Student have any of the following:
(5) Fever (100°F/37.8°C or higher) *
(6) Cough (for students with chronic cough due to allergies or asthma, a change in their cough from usual) *
(7) Severe headache, especially with a fever *
(8) Sore Throat *
(9) Loss of taste or smell. Children may say food "tastes bad" or "smells funny." *
(10) Difficulty breathing (for students with asthma, check for a change from their baseline breathing) *
(11) Vomiting or diarrhea *
IF YES to ANY of the above questions → Student CANNOT attend the program. Get your child tested for COVID-19.  CDC has a Coronavirus Self Checker* available in its website, which may help you make decisions about seeking medical care for possible COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/coronavirus-self-checker.html.  If NO to ALL above questions → Take the Student’s TEMPERATURE.
Take the Student’s Temperature
(12) Is the Student’s Temperature 100.4 degrees or higher? *
IF YES, Temperature is 100.4°F or higher → Student CANNOT attend the program. IF NO, Temperature is not 100.4°F or higher → Student CAN attend
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