By execution of this Statement, I affirm that my presence at named Parish on any day constitutes an affirmative representation on my part that I have performed the required health screening below and affirm that the responses to all questions are NO.
SCREENING QUESTIONS
“YES or NO, neither I nor my child(ren) have any of the following:”
• A fever of 100.4°F (38°C) or higher or a sense of having a fever during the past 72 hours
• New or unexpected cough that cannot be attributed to another health condition
• New shortness of breath or difficulty breathing that cannot be attributed to another health condition
• New chills that cannot be attributed to another health condition
• A new sore throat that cannot be attributed to another health condition
• New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise)
• New loss of taste or smell
• Nausea, vomiting or diarrhea
• Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19
“YES or NO, in the past 14 days, I have not done any of the following:”
• Cared for or had other close contact with a person suspected or confirmed to have COVID-19
• Travelled internationally
I understand that on any day when anyone in my household answers YES to any of the required health screening questions above, I am not permitted to participate in in-person Youth Ministry activities.