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VALLEY TRAILS CAMP
COVID DECLARATION . Please complete by Sunday 9 pm the week before your child attends Valley Trails Camp.
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1
Date
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Date
Month
Day
Year
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2
Campers name
Campers Name (Last Name, First Name)
Camper 1 Name (Last Name, First Name)
Camper 2 Name (Last Name, First Name)
Camper 3 Name (Last Name, First Name)
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3
Camper Names
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Add row for multiple campers
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4
COVID DECLARATION
*
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If yes to any question, please do not send your camper to Valley Trails for 24 hours or if experiencing COVID, contact doctor.
Yes
No
Have you traveled in last 14 days to area identified by the CDC as Level 3?
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Row 0, Column 1
Do you have any of these symptoms: Cough, sore throat, fever, upset stomach,runny nose?
Row 1, Column 0
Row 1, Column 1
Have you been around anyone who has tested positive for COVID?
Row 2, Column 0
Row 2, Column 1
Did your camper take any fever reducing medication in last 24 hours?
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Row 3, Column 1
Have you traveled in last 14 days to area identified by the CDC as Level 3?
Do you have any of these symptoms: Cough, sore throat, fever, upset stomach,runny nose?
Have you been around anyone who has tested positive for COVID?
Did your camper take any fever reducing medication in last 24 hours?
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
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5
COVID Declaration Terms and Conditions
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Declaration is mandatory before entry to camp. Your child may be sent home if not filled out. Please read the terms of the Declaration
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Parent/Guardian Name
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First Name
Last Name
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