Camp: Health Screening Checkpoint

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Health Screening Checkpoint: Camp

Important Information

This form should only be filled out the day before your scheduled camp begins.

If you answer “yes” to any of the following questions in the Screening Questionaire below, your child’s participation in our camps could unfortunately be impacted.

In addition, a temperature check point and log is required and will be implemented for all campers entering the studio during the camp or event.

If you or anyone in your home has one or more symptom(s) that may be related to COVID-19, please stay home and we’ll work with you to reschedule your reservation.

Screening Questionaire

* Indicates required field

Participant's Name *

First

Last

Sibling(s)'s name(s) *

Parent/Legal Guardian *

First

Last

Only required for child participants.

Preferred Phone Number *

Email *

Camp/Program or Event/Birthday Party Location *

Wilton Fairfield

1. Have you had anyone in your home experiencing any of the following symptoms that cannot be attributed to another health condition in the past 2-14 days?

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

1. yes or no? *

Yes No

2. Have you had anyone in your home had contact with a person known to be infected, potentially infected, or exposed to someone infected with COVID-19 within the previous 14 days?

2. Yes or no? *

Yes No

3. Have you had anyone in your home or someone you’ve been in contact with traveled domestically or internationally in the last 14 days?

3. Yes or no? *

Yes No

4. Have you had anyone in your home or someone you’ve been in contact with traveled to any of the states identified in Connecticut's travel advisory?

https://portal.ct.gov/Coronavirus/travel
- Link for reference of affected states. Please note that this link will open up a new tab in your browser.

4. yes or no? *

Yes No

Please acknowledge the following: *

I certify that all answers are true and correct to the best of my knowledge on behalf of my child(ren) and family.

⚠️ COVID-19 Disclaimer:
We have taken enhanced health and safety measures for all our customers and staff. You must follow all posted instructions while visiting our studio.

In any public place where people are present, there is an inherent risk of exposure to COVID-19. This is an extremely contagious disease that can potentially cause severe illness and death.

According to the Centers of Disease Control, senior citizens and those with underlying medical conditions are especially vulnerable. By visiting Happy Hands you voluntarily assume all risks related to exposure to COVID-19.

Together, we can help keep each other safe and healthy.

Agree to terms? *

I have read and agree to the follow terms and conditions.

Signature *

Date (MM/DD/YYYY) *

Submit