Features Pricing Templates Showcase

ESENPT

Features Pricing Templates Showcase Log in Sign up free

Home / Templates/ Healthcare/ Day Camp Camper Health Screening Form

Day Camp Camper Health Screening Form

Checks a camper's health status, travel history, and vaccination record before they join day camp activities.

Use this template

Already have an account? Log in

Name

Nombre

Apellido

Date of Birth

Gender

Male Female Other

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Phone Number

School Name

Grade Level

Parent/Guardian Name

Nombre

Apellido

Parent/Guardian Phone

Parent/Guardian Email

Emergency Contact Person

Nombre

Apellido

Emergency Contact Person Phone

Is your child experiencing any COVID-19 symptoms within 48 hours? Please select all the symptoms below (If none, please leave this field blank):

Fever Cough Shortness of breath Sore throat Loss of taste or smell

Did the camper have any travel history within the last 7-14 days?

Yes No

Is it out of state travel or international travel?

Out of state International Both

Was the camper had been in close contact or proximity to someone who's been tested for COVID-19 within the last 14 days?

Yes No

Is the camper currently living in the same household to someone who is positive for COVID-19?

Yes No

Has the child been vaccinated for COVID-19?

Yes No

What is the vaccination date?

Is it for first dose or second dose?

First dose Second dose

Authorized Person Signature

Sign here

Date Signed

Related templates

3 Day Diet Diary Form Healthcare 360 Assessment Report Preparation Form Human Resources 4D Lifestyle Assessment Form Assessments 4-Point Inspection Form Insurance

Powerful online forms — builder, logic, products, and teams — at a price that makes sense.

Product

Features
Pricing
Compare
Alternatives
Templates
Claude
API
GitHub

Company

Press room
Brand kit
Contact

Legal

Terms of service
Privacy policy
Cookie policy

Rejoining the server...

Rejoin failed... trying again in seconds.

Failed to rejoin.
Please retry or reload the page.

The session has been paused by the server.

Failed to resume the session.
Please retry or reload the page.