theZONE Weekly COVID Protocol Survey
Each of the following questions must be answered truthfully to the best of your ability to help ensure the safest environment for each child and volunteer while attending theZONE at EFBC. Thank you for your understanding and assitance.
Have you, your child, or anyone in your household been diagnosed with or exhibited symptoms of COVID within the past 14 days?*
 No
 Yes (child)
 Yes (myself or family member)
Have you, your child, or anyone in your household been knowingly exposed to someone diagnosed with, or exhibiting symptoms of COVID within the past 14 days?*
 No
 Yes (child)
 Yes (myself or family member)
Do you agree to allow your child(ren) to have their temperature checked before being admitted to theZONE?*
 Yes
 No
Do you agree to have your child(ren) wear a mask during their time at theZone?*
Do you agree to immediately return to pick up your child(ren) if they begin to exhibit symptoms of COVID while attending theZONE?*
 Yes
 No
Name of child(ren):*
Parent/Guardian submitting form:*


Submit