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COVID-19 Daily Health Screening Form
Please do not come to the clinic if you have had symptoms consistent with COVID-19, have been exposed or have tested positive for COVID-19.
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* Indicates required question
Parent or guardians email
*
Your answer
Parent or Guardians phone number
*
Your answer
Full Name of Camper
*
Your answer
Is the camper feeling sick?
*
Yes
No
In the past 14 days, has the camper been in close contact with anyone that has or had symptoms of COVID-19 that required you to quarantine?
*
Yes
No
Has the camper experienced any of the following symptoms in the past 48 hours?
*
Fever or chills
Cough
Shortness of breath or difficulty breathing
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Vomiting or diarrhea
None of the above
Required
Electronic Declaration
*
I hereby acknowledge that the details above are true and correct to the best of my knowledge.
Required
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