COVID-19 Pre-Screening Kids Kuts Voorhees COVID-19 Pre-Screening We require that you fill this pre-screening out in full before you arrive for your child's appointment. OK Question Title * 1. Date your child(rens) appointment(s) Date / Time Date OK Question Title * 2. Name of guardian escorting the child(ren) to the appointment: OK Question Title * 3. Guardians CELL phone number OK Question Title * 4. Name of children receiving hair services: Child 1: Child 2: Child 3: Child 4: OK Question Title * 5. Has anyone in your household been diagnosed with COVID-19 in the past two weeks? Yes No OK Question Title * 6. Has anyone in your household shown signs or symptoms of COVID-the past two weeks? Yes No OK Question Title * 7. Do you agree if you, your child(ren), or anyone in your household develops any symptoms of COVID-19 within the next two weeks, you will notify Kids Kuts Voorhees at (856) 770-9292? Agree Disagree OK Question Title * 8. Do you agree if you, your child(ren), or any member of your household tests positive for COVID-19 within the next two weeks you will contact Kids Kuts Voorhees at (856) 770-9292? Agree Disagree OK Question Title * 9. Do you understand that if you report anyone in your household as having COVID-19 symptoms OR have had a positive Covid-19 test within the past two weeks you can not be permitted to enter Kids Kuts Voorhees? Yes No OK DONE