Daily Covid Form - Camp Gan Israel

Every morning, before leaving to camp, all employees, parents, campers, siblings and essential visitors must complete this health screening questionnaire.

Please note: Camp will have touchless thermometers on site and will be screening every camper, staff member and visitor before entering. If employees, volunteers, parents, children and essential visitors cannot take their temperature at home, but answer "No" to all other questions, they may report to camp and have their temperature taken on site.

Is you or your child's temperature higher than or equal to 100.04 degrees Fahrenheit?*

YesNo

Have you or your child had any known contact with a person confirmed or suspected to have COVID-19 in the past 14 days?*

YesNo

Are you or your child currently experiencing ANY of the following symptoms?Leave blank if answer is no

Have you or your child tested positive for COVID-19 through a diagnostic test in the past 14 days?*

YesNo

If you have answered "NO" to all questions, you have passed and may enter camp.
If you have answered "YES" to any question, you will not be allowed to enter camp.

Attestation: By signing this document, I agree that the above statements are true. (Please fill in what is applicable to you)

Name*

First NameLast Name

Position*

Staff MemberParent

Camper 1

First NameLast Name

Camper 2

First NameLast Name

Camper 3

First NameLast Name

Signature*

Date*

MonthDayYear

Daily Covid Check List

Attestation: