Brookline Tennis Academy Camp / Roxbury Latin Covid-19 Daily Health Screening
This form is to be completed EACH DAY by or on behalf of BTA campers and staff. If you must answer yes to any question, you may not participate in the Camp and should follow up with your doctor by phone.

It is the responsibility of each individual to immediately disclose if and when their response changes, such as if they begin to experience symptoms, including during or outside camp hours.

Staff: If you answered yes, please contact the Camp Director for further guidance.

Thank you.
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Camper's First and Last Name *
Email of Parent/Guardian/Caregiver *
Do you or anyone in your household have any of the following: Fever of 100° F or greater? New cough? Shortness of breath or difficulty breathing? *
Do you or anyone in your household have at least two (2) of the following symptoms: 1) Repeated shaking with chills? 2) Muscle aches and pains, headache, sore throat? 3) New loss of taste or smell, congestion or runny nose? 4)Nausea/vomiting, diarrhea or other unexplained severe illness? *
In the past 10 days, have you -- or anyone in your household -- received a positive result from a Covid-19 test using saliva, nose or throat swab (not a blood test)? *
Have you been identified as a Close Contact of anyone who is confirmed to have COVID? *
Do you or does anyone in your household have a pending Covid-19 test? *
In the past 10 days, were you -- or anyone in your household -- notified by your medical provider or the MA Test and Trace team to remain home because of COVID-19? *
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