Wee Care A Lot Bermuda

If these are any “Yes” responses, the staff member and children of the parent completing the form cannot enter the camp

Screening for Week 9: 08/18/2025 - 08/22/2025

Name*

	Yes	No
Are you on quarantine?

In the last 14 days*

	Yes	No
Have you tested positive for COVID-19?
Have members of your household tested positive for COVID-19?
Are members of your household in quarantine or suffering from Omicron symptoms (i.e., cold, sore throat, sniffles, headache, etc.; and not only temperature and prior/Delta symptoms or other out-of-date symptoms)?

I hereby confirm that the information I have given is accurate.

Signature *

Date *

Covid Screening