Camp Belknap Daily Health Screening
This form must be completed prior to coming on site. If there is more than one person in your party, each person must individually complete this form. IF YOU ANSWER YES TO ANY QUESTION OR HAVE A TEMPERATURE OF >100 - DO NOT COME TO CAMP. Please contact camp at 603-569-3475 to cancel your reservation.
Email address *
Name *
Have you been in close contact with a confirmed case of COVID-19 in the last 14 days? *
Have you had a positive COVID-19 test in the last month? *
Are you or anyone in your household awaiting the results of a COVID-19 test? *
Have you had a fever or felt feverish in the last 72 hours? *
Are you experiencing any respiratory symptoms including: a runny nose? *
Sore throat? *
Cough? *
Shortness of breath? *
Are you experiencing any new muscle aches or chills? *
Have you experienced any new change in your sense of taste or smell? *
Are you experiencing any symptoms of diarrhea, nausea or vomiting? *
What was your temperature before arriving at Camp Belknap? (Temperature must be below 100 to come to camp property. Contact camp to cancel reservation) *
A copy of your responses will be emailed to the address you provided.
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