COVID checklist for Treehouse Campout 2020

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Must be filled out prior to attending. You will also be temperature checked upon arrival.

First Name *

Last Initial *

Patrol *

Answer the following truthfully: *

Yes

I have a cough

I have a fever currently, or I have had one within the past 3 weeks

I have come in contact with any confirmed COVID-19 positive patients in the last 14 days

I am experiencing shortness of breath or difficulty breathing

I am experiencing flu-like symptoms, such as GI upset, headache, or fatigue

I have experienced recent loss of taste or smell

I am over the age of 60

I have heart, lung, or kidney disease, diabetes, or any auto-immune disorders

I have traveled in the past 14 days to any regions currently experiencing a COVID-19 outbreak

Yes

I have a cough

I have a fever currently, or I have had one within the past 3 weeks

I have come in contact with any confirmed COVID-19 positive patients in the last 14 days

I am experiencing shortness of breath or difficulty breathing

I am experiencing flu-like symptoms, such as GI upset, headache, or fatigue

I have experienced recent loss of taste or smell

I am over the age of 60

I have heart, lung, or kidney disease, diabetes, or any auto-immune disorders

I have traveled in the past 14 days to any regions currently experiencing a COVID-19 outbreak

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy