please answer the following questions accurately. fill out a form for each individual attending the retreat

Name

First Name

Last Name

Phone for Contact

(###)

###

####

Camper Name

First Name

Last Name

Group Name You Will Be Attending With?

Name of the Church, School, or organization you are coming with

Does the attendee currently, or have in the past 14 days, had a temperature over 100.4ºF?

Yes

In the Past 14 days, has the attendee been in close proximity to anyone who has tested positive for COVID-19?

Yes

Digital Certification

Check the box below if you certify that the responses provided above are true and accurate to the best of your knowledge.

Certification Box

Today's Date

YYYY