Pre-Arrival Health Screening Mountain Friends Camp 2025
All participants (campers, CITs, staff and volunteers) must complete and submit this form within 24 hours before your arrival at camp. Parent/guardian should monitor symptoms and complete on behalf of camper/CIT. If a participant answers "YES" to any of the below questions, we require additional clearance and permission from the director in order to participate in Mountain Friends Camp. Please notify director Anastacia Ebi (435-554-1132/ director@mountainfriendscamp.org) if you have responded "YES" to any question, or if anything changes before your arrival. Note that COVID-19 tests are only required this year if there are symptoms or exposure to infectious disease. Thank you for helping to keep our community healthy and safe for everyone!
Participant Name
*
First and Last name
Parent/ Emergency Contact Name
*
First and Last name
Phone Number (staff participant, OR camper parent)
*
-
Area Code
Phone Number
E-mail Address (staff participant, or camper parent)
*
example@example.com
COVID-19 and OTHER ILLNESS SYMPTOM and EXPOSURE CHECKLIST
1. Has the participant experienced any of the below symptoms in the past 10 days?
*
YES
NO
Fever (greater than 99 F)?
Cough?
Shortness of breath/difficulty breathing?
Sore throat?
Runny nose?
Chills/muscle pains?
Loss of taste or smell?
Vomiting/diarrhea?
Fatigue?
2. Has anyone in your household experienced any of the above symptoms in the last 10 days?
*
Yes
No
3. If yes to #2, are any of the symptoms above potentially due to prior health conditions?
Please explain
4. Has anyone in your household tested positive for Covid-19 in the last 10 days?
*
Yes
No
5. Has participant been around anyone with confirmed or suspected COVID-19 for more than 15 minutes, in the past 10 days?
*
Yes
No
Please fully explain any and all "Yes" answers above
COVID-19 Test Results Pre-Arrival
If you have been exposed or have symptoms of COVID-19, notification as well as a negative COVID-19 test is required within 24 hours of arrival. Please upload verification/image of your COVID-19 test taken prior to arrival at camp. Rapid Antigen test should be taken within 24 hours prior to arrival.
Upload test result/image here
Browse Files
Write name, date and time taken on test/paper and include in file, or share results from lab test with name and date
Cancel
of
Signature (click/drag)
Participant (or responsible adult for minor children) signature indicates that I monitored for symptoms daily for 14 days prior to camp and to the best of my ability. I understand that arriving to camp healthy is vital to a healthy camp for all campers and staff, but that we cannot rule out the possibility of infectious disease in a group living environment.
Submit
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