Camp Daily Wellness Check-in Form
Complete this form each day to help ensure the health and safety of all campers.
Camper Full Name
*
First Name
Last Name
Date of Check-In
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Cabin/Group Name
*
Temperature (°F or °C)
*
How are you feeling today?
*
Great
Good
Okay
Not well
Have you experienced any of the following symptoms since your last check-in? (Select all that apply)
*
Fever or chills
Cough
Sore throat
Headache
Shortness of breath
Loss of taste or smell
Stomach ache
None of the above
Other
Have you been in close contact with anyone who is sick or showing symptoms in the past 24 hours?
*
Yes
No
Are you currently taking any medication?
*
Yes
No
If yes, please list the medication(s) and dosage(s)
Rate your overall wellness today
*
1
2
3
4
5
Parent/Guardian or Emergency Contact Name
*
First Name
Last Name
Parent/Guardian or Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit Check-In
Should be Empty: