COVID-19 Youth Program Screening
*Please fill out a COVID-19 Screening for EACH individual child enrolled in a program.

In a continues effort to make CAC a safe environment, all participants must complete a health screening before/upon arriving at the club.

Our commitment to keeping the young people we serve safe is always our number one priority. All COVID-19 related concerns should be directed to General Manager Josh Smith,, or Youth Sports and Fitness Director Matt Soucy,
Today's Date *
Child's Name *
Parent/Guardian's Name *
Today or in the past 24 hours, have you or any household member had any of the following symptoms? *
In the past 14 days, has your child been identified as having had close contact with a person known to be infected with the novel coronavirus (COVID-19)? *
In the past 14 days, has your child been diagnosed with the novel coronavirus (COVID-19)? *
I understand by submitting this form I attest that the answers above are true. *
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