Camper & Party Wellness Check

inSPIRE Rock Gym Location*
What Location Are You Visiting Today?
Climbers Name*
First Last
SIGNS & SYMPTOMS OF COVID-19*
- None Of These
- Cough
- Shortness of breath or difficulty
- Chills
- Repeated shaking with chills
- Muscle pain
- Headache
- Sore throat
- Loss of taste or smell
- Diarrhea
- Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit
- Known close contact with a person who is lab-confirmed to have COVID-19
Please select any of the symptoms below that apply.
Does Your Climber Have:*
- None Of These
- An undiagnosed rash?
- Eyes that are red and itchy, and/or have “crusty” drainage?
- An untreated transmittable condition (such as head lice)?
Please select any of the symptoms below that apply.
Has Your Climber:*
- None Of These
- Had a fever or 100 degrees or more, or taken fever-reducing medicine, in the past 72 hours?
- Vomited/Thrown up in the past 72 hours?
- Had diarrhea in the past 72 hours?
- Been showing signs of any type of infectious disease, such as COVID-19*?
- Spent any time with someone who has been sick with COVID-19* or another infectious illness?
Please select any of the symptoms below that apply.
Notice*
- I understand that my child’s attendance at inSPIRE Rock camp may expose them to COVID-19 and therefore have been advised to keep my child from having direct contact with vulnerable people (anyone age 65 or older, or with pre-existing conditions) during camp and for 14 days afterwards.
Notice*
- I understand that I will be notified should any camper or staff test positive for COVID-19, and that I may choose to either pick up my child or allow my child to remain at camp.
Notice*
- I understand it is my responsibility to screen my child daily for these signs and symptoms and, if any arise, to keep them home from camp.
Signature*

inSPIRE Rock Indoor Climbing & Team Building Center

Summer Camp Is On!