Daily Camp Safety Questionnaire

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)

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):

Has your child or anyone in your household been diagnosed with Covid-19 in the last 14 days?

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.)

Thank you for your time!

Glazed Expressions Creative Studio

Pottery Painting, Glass Fusing, Clay and Canvas

65 Main St. S., Georgetown, ON 905-877-2224

Online Daily Covid-19 Camp Questionnaire

Please submit daily - we can not admit a camper without this questionnaire emailed to us every day.