Glazed Expressions Creative Studio
DIY Pottery, Glass Fusion and Canvas Painting
Georgetown, Ontario, Canada
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Online Daily Covid-19 Camp Questionnaire
Please submit daily - we can not admit a camper without this questionnaire emailed to us every day.
Name of Camper
Today's Date
Parent/Guardian Phone
Is the child running fever? (please take temperature daily)
No
Yes
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Has the child experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing):
Yes
No
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Has your child or anyone in your household been diagnosed with Covid-19 in the last 14 days?
Yes
No
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Is your child currently experiencing any of the following? Sore throat • Difficulty swallowing or breathing • New olfactory or taste disorder(s) • Nausea/vomiting, diarrhea, abdominal pain • Runny nose, or nasal congestion (in absence of underlying reason for these symptoms such as seasonal allergies, post nasal drip, etc.)
No
Yes
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Submit
Thank you for your time!
