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 There are no weeks for the current year

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symptoms (i.e., cold, sore throat, sniffles, headache, etc.; and not only temperature and prior/Delta symptoms or other out-of-date symptoms)?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