Daily Active Screening Questionnaire for Summer Camp Participants 2021
Active Screening is a health review of your child. Completing Active Screening daily is a mandate of the Ministry of Health and Ottawa Public Health for participation in day camps. Submitting this Questionnaire makes it easy for you to comply.

It helps everyone remain safe and healthy!

Information collected will only be used by the Manor Park Community Council (MPCC) for the administration and management of 'Summer Day Camps in Manor Park' and will only be shared if legally required.
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I hereby declare that the below information is truthful *
Participant's Name *
Does the participant have one or more of the following symptoms?  Check all that apply. Those who have 1 or more symptom will unfortunately not be able to attend the program or enter the facility. *
Does the participant have an new or developing inflammatory condition? Check all that apply. Those who have 1 or more symptom will unfortunately not be able to attend the program or enter the facility. (If the condition is chronic - please supply a doctor's note electronically to camp Supervisor before arrival at camp) *
I attest that: The participant has NOT travelled outside of Canada in the last 14 days; A doctor, health care provider, or public health unit has NOT told me that the participant should currently be isolating (this could be because of an outbreak or contact tracing); The participant has NOT had been identified as a "close contact" with a confirmed or probable Covid-19 case in the last 14 days; The participant has NOT had close contact with a person with acute respiratory illness who has been outside of Canada in the last 14 days; The participant has NOT received a COVID Alert exposure notification on their cell phone. *
I attest that there is no person(s) with whom the participant lives with, that is currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms. (If the individual experiencing symptoms received a COVID-19 vaccine in the last 48 hours and is experiencing mild headache, fatigue, muscle aches, and/or joint paint that only began after vaccination, select 'Yes, I attest'.)
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I have received and read the 'Summer Day Camps in Manor Park: Guide for Parents and Guardians 2021', NOTE:  Also available at manorpark.ca  *
Participants should NOT attend camp if they, or anyone in their household(s) are experiencing any symptoms or are sick.
If at any point you have clicked 'No, I do not attest", you should not bring the participant to camp. Please contact the camp supervisor for direction.
Notice of Risk from Ottawa Public Health:
When children from multiple families attend a day camp, there is an increased risk of the Covid-19 virus coming into the camp. Children who are infected with the Covid-19 virus are more likely than adults to have very mild infections or to have no symptoms at all, but these children can still transmit the infection to other children and to adults at the camp.  This means that children can bring home an infection acquired in a camp and put other persons at risk. Even if a day camp has a screening process to help detect infections when there are symptoms; this screening process will not detect infected children or adults who do not have symptoms at the time of screening.  
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