Lincoln Summer Camp-tivities Daily Health Screening Form
Name of Adult completing this Form *
Name of participant *
Date *
MM
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DD
/
YYYY
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):
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 *
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