Awana Weekly Check-in

Awana Weekly Checkin
Please do not fill out this form until the day of the afternoon of Awana each week.
Today's Date *

Month Day Year
Date
Clubber Name *

First Name Last Name
Awana Club *

Cubbies - (Ages 3 - 5) Sparks - (Kindergarten - 2nd grade) T&T - (3rd grade - 6th grade) Trek - (7th grade - 8th grade) Journey - (9th grade - 12th grade)
Does this child have symptoms consistent with COVID19? *

Yes No
Has this child been in direct contact within the last 14 days with someone who has had a positive case of COVID19? *

Yes No
Has this child tested positive of COVID19 in the last 14 days? *

Yes No
Is this child awaiting the results of a COVID19 test that has been administered due to symptoms or suspicion of contracting COVID19? *

Yes No
Parent Signature *

Clear
Should be Empty:

Awana Weekly Checkin