2021 KaleidAScope Summer Picnic Registration
Please fill out this form with all of the required information in order to register for KAS's annual summer picnic. We need to know the name and contact information of all individuals that will be coming with you to the picnic.
The picnic will run from 4pm - 8pm on Thursday, June 17th at Camp Sherwin (8600 West Lake Road;
Lake City, pa 16423) RAIN OR SHINE. All PA Covid Mitigation Rules will be observed (example: masks, social distancing, etc.)
YOUR name (first and last) *
YOUR Email *
YOUR Phone number *
List the NAME and PHONE NUMBER of EVERY person who will be coming with you to the picnic (not including KAS staff). If you are coming to the picnic by yourself, write NA *
COVID-19 Responsibilities
The health and safety of our picnic guests is our number one priority. We ask that if you believe you have been in contact with anyone who may have symptoms of COVID-19 or you experience one or more COVID 19 symptoms from Group A or two or more symptoms from Group B, please stay home and contact your health care provider.

COVID 19 Symptoms - Group A
 Fever (≥100.4 F oral or equivalent)
 Cough
 Shortness of breath
 Difficulty breathing
 New olfactory disorder
 New taste disorder

COVID 19 Symptoms - Group B
 Chills
 Rigors
 Myalgia
 Headache
 Sore throat
 Nausea or vomiting
 Diarrhea
 Fatigue
 Congestion or runny nose

Additionally, we ask that you please contact the KaleidAScope, Inc. office if you and/or someone in your party tests positive for COVID-19 within 14 days after the event.
By writing my full name below, I acknowledge that I have read and understand the COVID-19 Responsibilities. I will follow these guidelines. (write your full name in the answer box) *
I give KaleidAScope, Inc. permission to use my likeness (video/photo) from this event in marketing, social media, and other outreach materials. *
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