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Camper Wellness Check
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Camper Wellness Check
inSPIRE Rock Gym Location
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Select Cypress Or Spring
Spring, TX
Cypress, TX
What Location Are You Visiting Today?
Climbers Name
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First
Last
SIGNS & SYMPTOMS OF COVID-19
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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:
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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:
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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
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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
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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
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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
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