COVID-19 Questionnaire

COVID-19 Questionnaire

Due to the inherent risks associated with COVID-19, the U.S. Space & Rocket Center and Space Camp (USSRC) has implemented procedures and policies for the protection of campers and staff. Please read below and complete all information. Completion of this document is required one week before camp attendance.

Number of Attendees*

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Camper First Name*

Camper Last Name*

Program*

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Camp Start Date*

First Name*

Last Name*

Program*

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Start Date*

First Name*

Last Name*

Program*

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Start Date*

First Name*

Last Name*

Program*

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Start Date*

I affirm I am the guardian of the listed camper(s) and have read and understand the current Centers for Disease Control and Prevention guidelines regarding people at high risk for severe illness from COVID-19 and other populations of concern.

I understand*

I affirm the camper(s) listed does(do) not suffer from nor has ever suffered from any of the listed health concerns or, if they do, I affirm that I have made the USSRC and Space Camp aware by confirming this on the Space Camp health form. I further accept all liability for sending my camper(s) to camp with the noted health risks during the COVID-19 pandemic.

I understand*

To reduce the risk of infection, Space Camp is following guidance from the and recommending social distancing and frequent handwashing. We will require masks if warranted by the CDC guidance for the community level of Madison County, AL. If the camper is immunocompromised or high risk for severe disease, we suggest that you contact your healthcare provider for guidance on whether they need to wear a mask and take other necessary precautions. Masks are optional for any camper except where noted below. We ask that you cover these topics with your camper(s) prior to Camp. These guidelines are for the safety of everyone. Campers who refuse to follow the guidelines will be subject to removal from Camp.

I understand*

All campers and accompanying parent/guardian will undergo a short medical screening including a temperature check before entering our campus. Please review the following questions:

Have you been in close contact with a confirmed case of COVID-19 with in the last 10 days?
In the past 24 hours have you experienced:
Fever of 100.4 degrees or higher
A cough, shortness or breath or sore throat?
A new loss of taste and smell?
Vomiting or diarrhea?

If the parent/guardian or camper answers yes to the previous questions, they will not be allowed entry or be able check into Camp. Campers will be sent home if they have a fever of 100.4 or above at any time during Camp.

I have read and understand this condition of entry to Camp.*

I understand that if anyone in close contact with my camper (teammates or staff) presents with symptoms, the team will be asked to mask indoors for the remainder of the session to reduce risk of spread.*

I understand that if my child presents with COVID-19 symptoms, as defined by the CDC, they will be removed from Camp activities and sent home.*

I understand that if my camper has an exposure to a COVID-positive camper, staff member, or Rocket Center visitor while at Camp, Space Camp will follow the guidance provided by the CDC and American Camps Association as follows:*

Regardless of vaccination status, if my camper has no symptom, he/she/they is welcome to remain at camp but will be required to wear a mask while indoors per CDC guidance.

Campers and staff members with COVID-19 symptoms are required to LEAVE camp for the required isolation period regardless of vaccination status.

We ask that parents develop a firm plan for being enroute to pick up your child within 8 hours of notification to ensure the safety of all our campers and staff.

An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, guests with underlying medical conditions are especially vulnerable. By visiting the U.S. Space & Rocket Center, home of Space Camp, you voluntarily assume all risks and liability related to COVID-19 exposure and agree to hold the Alabama Space Science Exhibit Commission d/b/a the U.S. Space & Rocket Center and its employees and volunteers harmless should infection occur.

Today's Date*

Parent/guardian First Name*

Parent/Guardian Last Name*

Registration email*

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