Country Camp Health Screen Question Title * 1. Child's Name Question Title * 2. Has your child had a temperature of 100.4 or higher in the past 24 hours? Yes No Question Title * 3. Is your child experiencing any of the following symptoms? Fever Chills, shaking, sweating Shortness of breath or difficulty breathing Cough Dizziness Muscle pain Headache Sore throat Gastrointestinal discomfort Loss of taste or smell None of the above Question Title * 4. In the past two weeks, has your child been in contact with someone diagnosed with COVID-19? Yes No Question Title * 5. Has your child been in close contact with anyone who is waiting for a COVID-19 test result? Yes No Submit