Cowemoki Summer Enrichment Program COVID-19 Symptom Monitoring Form
Please fill out this survey each day morning bringing your child to our program.
Child(ren)'s First and Last Name *
First and Last Name of person filling out this form *
Are you, your child(ren), and/or anyone in your household currently experiencing any of the following symptoms? *
To the best of your knowledge, have you, your child(ren), or anyone in your household been in direct contact with anyone who has been exposed to COVID-19 in the past 14 days? *
Best Phone Number to reach Parent/Guardian today
Confirmation *
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