COVID-19 SCREENING  QUESTIONAIRE
To ensure a Healthy and Safe camp environment that aligns with the Federal and Provincial COVID-19 safety requirements, registered campers, staff, volunteers and visitors need to PASS ALL COVID-19 SCREENING Questions in order to be able to join the Zachary's Camp. Temperature may be taken at check in
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Campers Name *
Reason for checking in *
Agency:
Your name (person filling out the screening) *
Phone number you can be reached today *
In the last 14 days, have you or anyone you live with travelled outside of Canada *
Has a doctor, healthcare provider, or public health unit told you that you should currently be isolating? *
In the last 14 days, have you been identified as a "close contact" of someone who currently has COVID -19 *
Are you currently experiencing any of these symptoms Please contact Antje 519-215-6465 *
Required
Has the person successfully passed the CORVID-19 Self Assessment today? *
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