Required fields are marked with asterisks (*)

COVID-19 Camper Screening Form

The health and safety of your child is Camp PRC's first priority. We are monitoring the COVID-19 pandemic closely and will periodically update our policies and procedures based on the latest public health recommendations.

We require all parents/caregivers to fill in one screening form, per child, per day, at least 30 minutes prior to arriving at Camp PRC. If you have any difficulties with the form, staff will be able to assist you on site. Your honest answers will help us keep everyone safe.

Collection of Personal Information

Personal information on this form is collected in accordance with the Municipal Freedom of Information and Protection of Privacy Act. It is to be used for the purpose of administering health and safety precautions within municipal facilities. Any questions regarding the collection, use and retention of personal information on this form can be directed to the Town Clerk (clerksoffice@town.stmarys.on.ca).

Date

Time

Child's full name

Program attended by child:

Camp PRC

Temperature (37.8 degrees C/100.04 degrees F or above is considered a fever)

Does your child have any of the following new or worsening COVID-19 symptoms, not related to causes or conditions they already have?

Fever and/or chills; cough or barking cough (croup); shortness of breath; decrease or loss of smell or taste; sore throat or difficulty swallowing; runny or stuffy/congested nose; nausea, vomiting and/or diarrhea?

Yes

Is your child experiencing headache, extreme tiredness and/or muscle aches? If the child received a COVID-19 vaccination in the last 48 hours and is experiencing mild headache, fatigue, muscle aches or joint pain that began after vaccination, select “No.”

Yes

Has your child travelled outside of Canada in the past 14 days?

Yes

Is someone that the child lives with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

Yes

In the last 14 days, has your child received a COVID Alert exposure notification on their cell phone?

Yes

Has a health care provider, or Huron Perth Public Health told you that the child should currently be isolating (staying at home)?

Yes

FormBuilder

COVID-19 Camper Screening Form

Collection of Personal Information