Agape Valley Bible Camp Daily Home Screening Form
Please complete form daily prior to coming to camp. This electronic screening process will help minimize contact with staff as well as keep drop off times quick and efficient. We trust that we are all working together to ensure the safety of each camper and staff, as well as the greater community. Thank you for taking this extra step to help!

This form is time stamped, so it will automatically save the date and time you entered your information.

If you answer YES to any of these questions, let us know, stay home and self-isolate right away.
Call your health care provider or the COVID-19 Info line at 905-688-8248 and a public health professional will give you detailed instructions to follow to protect you, your family and members of the public.
Email *
Child(ren) names *
Have you, or anyone in your immediate family have any of the following: *
Yes
No
New cough or a cough that is getting worse
Difficulty breathing
Shortness of breath (even when sitting or walking regularly)
Sore throat (not due to allergies)
A runny or congested nose (not due to allergies)
Unusual level of fatigue
Unusual headache
Nausea/vomiting, diarrhea, or loss of appetite
Feeling unwell for an unknown reason
Decrease or loss of taste or smell
Have you, or anyone in your immediate family have any of the following: [Fevers/Chills]
In the last 14 days have you travelled outside of Canada *
Have you had contact with or live with anyone currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms. *
Submit
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