EmailMe Form - Camp Shalom Camper Covid Screening

Please list all campers that you are checking in.

Your Name (Parent/Guardian) *

First Last

Camper's Name (1) *

First Last

Camper's Name (2)

First Last

Camper's Name (3)

First Last

Camper's Name (4)

First Last

Camper's Name (5)

First Last

NOTE: When the option of [5/10] days is listed:

• Use 5 days if you are fully vaccinated AND/OR 11 years old or younger
• Use 10 days if you are 12 years old or older and not fully vaccinated OR if you are immunocompromised.

Anyone who is sick or has any new or worsening symptoms of illness, including those not listed below, should stay home until their symptoms are improving for 24 hours (or 48 hours for nausea, vomiting, and/or diarrhea) and should seek assessment from their health care provider if needed.
You may select “No” to all symptoms if all of these apply:
• You have completed your isolation of [5/10] days OR you tested negative for COVID-19 on one PCR test or rapid molecular test, or two rapid antigen tests taken 24 to 48 hours apart AND
• You do not have a fever AND
• Your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).

Do any of your campers have any ONE of the following symptoms in the last [5/10] days? *

No

Yes

Fever and/or chills - Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher.

Cough or barking cough (croup) - Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions you already have).

Shortness of breath - Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have).

Decrease or loss of smell or taste - Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have.

Do any of your campers have TWO OR MORE of the following symptoms in the last [5/10] days? *

No

Yes

Sore throat or difficulty swallowing - Painful swallowing (not related to seasonal allergies, acid reflux, or other known causes or conditions you already have).

Runny or stuffy/congested nose - Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have.

Headache - Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes or conditions you already have).

Nausea, vomiting and/or diarrhea - Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions you already have.

Extreme tiredness or muscle aches - Unusual, fatigue, lack of energy (not related to depression, insomnia, thyroid disfunction, sudden injury, or other known causes or conditions you already have).

In the last [5/10] days have you tested positive for COVID-19? *

No

Yes

This includes a positive COVID-19 test result on a lab-based PCR test, rapid molecular test, rapid antigen test or home-based self-testing kit.
Select “No” if you have already completed your isolation period of [5/10] days
because your symptoms started before your positive test result AND:
• your symptoms have been improving for 24 hours (48 for nausea, vomiting,
and/or diarrhea) AND
• you do not have a fever

Has a doctor, health care provider, or public health unit told any of your campers that they should currently be isolating (staying at home)? *

No

Yes

Do any of the following apply to any of your campers? *

No

Yes

• They live with someone who is currently isolating because of a positive COVID-19 test
• They live with someone who is currently isolating because of COVID-19 symptoms
• They live with someone who is isolating while waiting for COVID-19 test results
• In the last 14 days, they travelled outside of Canada and were told to quarantine.
• In the last 14 days, they travelled outside of Canada and were told to not attend school/child care.