Camper Wellness Check - inSPIRE Rock Indoor Climbing & Team Building Center

inSPIRE Rock Gym Location*

What Location Are You Visiting Today?

Climbers Name*

First Last

SIGNS & SYMPTOMS OF COVID-19*

Please select any of the symptoms below that apply.

Does Your Climber Have:*

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*