Winter 2021 Participation Please complete this questionnaire to determine if your Kinetic Kid is appropriate for in-person programs this season. OK Question Title * 1. Child's name OK Question Title * 2. Would you be able to provide an adult volunteer for your child? (Parent, caregiver, sibling, etc. over 16 y/o) Yes No OK Question Title * 3. Is your child able to maintain social distance guidelines, with or without parent/adult supervision? Yes No OK Question Title * 4. Is the adult volunteer able and willing to wear a mask at programs? Masks are required at check-in and anytime within 6 feet of someone outside your household. Yes No OK Question Title * 5. Equipment shared between participants will be limited and sanitized when used. Is your child able to maintain cleanliness with any shared equipment? (refrain from putting hands in mouth, putting equipment in mouth, etc.) Yes No OK Question Title * 6. Would your child be successful in a class without 1:1 assistance from you or another volunteer? Yes No Other OK DONE
