Lincoln Summer Camp-tivities Daily Health Screening Form
Name of Adult completing this Form
Name of participant
What is the partcipant's temperature today?
Today or in the past 24 hours, have you or any household members had any of the following symptoms (check if yes):
Fever (temperature of 100.0 degrees or above)?
Felt feverish, but no actual fever?
New loss of smell/taste?
New muscle aches?
Any other signs of illness?
In the past 14 days, has the camper had close contact with a person known to be infected with the novel coronavirus (COVID-19)?
In the past 24 hours, has the participant taken fever-reducing medicines (Motrin, Tylenol, Advil, etc.)?
By writing your full name below, you attest that the information provided above is true to the best of your knowledge.
Based on the information above
I (or my dependent) will NOT be participating in the activity
I (or my dependent) will be participating in the activity
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