Hand Hygiene

HEALTH SCREENING

QUESTIONNAIRE

In order to ensure the health and safety of our clients, staff, and community, it is important that all those attending any of our services complete this health questionnaire, please fill out the following form.

This form should be filled out no more than 1 day before your event/camp to ensure that the answers given are still valid during your time at Happimess. 

Please note that this form must be submitted prior to your event/camp.

If you have any questions or concerns with the completion of this form, please contact our administrative team at 6048373890

Family Information 

Gender

         Custody  

Any Custody Restrictions?

         Emergency contacts  

Please note that we require photo ID to authorize pick-up by anyone other than yourself. 

   Health 

Has your child had any of the following symptoms in the last two weeks: Cough | Shortness of Breath/Difficulty Breathing | Runny Nose or sneezin | Nasal Congestion/Stuffy Nose | Hoarse voice | Sore throat/Painful Swallowing | Difficulty swallowing | Nausea/Vomiting/Diarrhea/Unexplained Loss of Appetite
Has your child had a fever (37.5°C or higher) in the last 2 weeks?
Have you, or anyone in your household travelled outside of BC in the last 14 days?