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The Jumping Jungle: Covid-19 Health Declaration Form
In an effort to reduce the risk of COVID-19 exposure to Jumping Jungle employees and patrons, Each Adult guests must complete the following screening questions for themselves and their kids.
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* Indicates required question
Email
*
Your email
Date of Declaration:
*
MM
/
DD
/
YYYY
Parent/Guardian name
*
Your answer
Phone Number
*
Your answer
Name(s) of members in the camp/playgroup (please put the relationship next to the name):
*
Your answer
Has any of the visiting guests traveled Internationally or been in close contact with anyone who has traveled Internationally within the last 14 days?
*
Yes
No
Has any of the visiting guests been in close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?
*
Yes
No
Has any of the visiting guests experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath, or other respiratory problems)?
*
Yes
No
Guests answering yes to any of the above questions will not be permitted access to The Jumping Jungle’s premises. I AGREE to notify Jumping Jungle (by email to
info@jumpingjungle.com
) of any change in status, of any of the visiting guests. The change in status includes diagnosis with Coronavirus and/or quarantine, within twenty-one(21) days following your visit to The Jumping Jungle.
*
I Agree
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