Summer Recreation Program COVID-19 Daily Screening Questionnaire

SUMMER PROGRAM COVID-19 HEALTH DECLARATION FORM

To prevent the spread of COVID-19, this form MUST be submitted BEFORE your child arrives at Summer Program each day.
  • Date Format: MM slash DD slash YYYY
  • 1. Fever or signs of a fever, such as chills, sweats, muscle aches, and lightheadedness) 2. Cough 3. Headache 4. Runny nose 5. Painful swallowing 6. Diarrhea 7. Loss of sense of smell or taste 8. Unexplained loss of appetite 9. Small red or purple spots on hands and/or feet?