Required fields are marked with asterisks (*)

Pre-Program Declaration of Health Tracking

Welcome Back Campers!

We thank you in advance for completing this Pre-Program Declaration of Health for Summer Day Camps.

We are so excited to have your campers back with us this summer and we cannot beleive it's been so long since we've see the smiling faces.

Please complete the below form to provide information abour your camper as well as a pre-progam screen.

Please note that this is required to be completed before EACH camp you child(ren) are registered and plan on attending this summer.

Upon arrival each day at camp a daily screening will be required.

Paricipant 1's Full Name:

Participant 2's Full Name:

Participant 3's Full Name:

Are the Participants.....

Campers

Volunteers

Personal Support Worker

Please select the camp that the particiapnts are attending next week:

July 5-9 - Classica Camp #1

July 12-16 - 007 Spy Camp

July 19-23 - My Camp's Got Talent

July 26-30 - Classic Camp #2

August 3-6 - Abstracts & Art Camp

August 9-13 - Environmental Explores

August 16-20 - Young Einstein's

August 23-27 - Classic Camp #3

August 30 - September 3 - Nature Nut Camp

Are you sick with a cold/flu or are displaying an signs of COVID-19 and/or flu-like symptoms?

Yes

Do you have any of the following symptoms which are new or worsened if not associated with allergies. chronic or pre-exsiting conditions: fever, cough, shorness or breath, difficulity breathing, sore throat and/or runny nose?

Yes

Have you returned from outside the province (including Canada/ USA) in the past 14 days?

Yes

In the last 14 days, did you have close contact with someone who has a probable or confirmed case of COVID-19?

Yes

In the past 14 days, at work or elsewhere, did you have close contact with a person who had acute respitatriy illness who returned from travel outside of the country in the 14 days before they became sick?

Yes

In the past 14 days have you been directed by Public Health to self-isolate?

Yes

Is the participant(s) allowed to use Hand Sanitizer while in the care of the Township of Wilmot day camps?

Yes

PROGRAM BEHAVIOUR EXPECTATIONS (Camp Rules) I promise to: Keep your hands and feet to yourself, Speak nicely/positively to each other, Touch only what belongs to you, stay within the activity area and Listen to your leaders.

Do(es) you agree to follow the camp and COVID-19 rules as shown above? Yes

I promise to: Stay 6 feet away from other campers and leaders, Wash my hands before and after eating and before changing activies, Cover my cough or sneeze, Not touch my face, nose or eyes with dirty hands, Let the leader know if you don't feel well.

Do(es) the participant(s) agree to follow the camp HEALTH AND SAFETY EXPECTAIONS (COVID-19 rules) as shown above? Yes

Has the Day Camp Participant Information Package been submitted?

Yes

Are Medications Required?

Yes - Please remember to complete the Camper Medical Administration Form

Does the participant(s) plan on wearing a mask while at camp? **Please note that we will be following the guidelines and by-laws from Waterloo Region Public Health**

Yes

I acknowledge the screening must be completed daily, either ahead of sign-in with a photo or print out showing the green checkmark, participants name and current date, or at drop off.

Yes

Do you have any questions or concerns?

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Pre-Program Declaration of Health Tracking

Welcome Back Campers!