CUB's Registration
* Required
Email address
*
Your email
Child's Age
*
2
3
Child's Name
*
Your answer
Has child or anyone else in household been sick in the last 72 hours?
*
Yes
No
Have you or your immediate household been in contact with anyone who has contracted COVID-19 in the last 14 days? *
*
Yes
No
Are you or your child experiencing any of the following symptoms?
*
Fever exceeding 100.0 (F)
Shortness of Breath
Cough/Sore Throat
Headache
Loss of taste/smell
N/A
Required
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