2021 Daily Health Screening Form: Valley Village Art Camp
Each camper must complete and submit this form each day before arriving to campus.
When you arrive, please show your completed page (you can take a screen shot of it, or you can show us your emailed receipt)
 
If you have 2 campers, please fill in this form 2 separate times.
If you have 3 campers, please fill in this form 3 separate times.
 
If the answer to any of the following questions is YES, you must STAY HOME.
Parents, has your child had contact with a person known to be infected with or suspected to have Coronavirus Disease (COVID19) within the last 10 days? *
Has your child traveled outside of the state of California in the past 7 days? *
Has your child experienced any of the following symptoms in the past 24 hours?
In the last 48 hours, has/have your child(ren) experienced any of the following symptoms:
Signature *
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