Health and Daily Screening Form - CGI

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 . 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.

If you child is absent please let us know the reason

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

Yes No

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

Yes No

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?*

Yes No

Is you child absent

Yes No

Reason for being absent

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 Name Last Name

Position*

Staff Member Parent

Camper 1

First Name Last Name

Camper 2

First Name Last Name

Camper 3

First Name Last Name

Signature*

Date*

Month Day Year

Daily Health Check List and Absent Notification

Attestation: