Kids Group Information Card

Event Time


Does your child have a cough?
Has your child experienced recent loss of taste or smell?
Does your child have a fever now or have they in the past 14-21 days?
Is your child experiencing shortness of breath or difficulty in breathing?
Has your child come in contact with any confirmed COVID-19 positive patients in the last 14 days?
Is your child experiencing other flu-like symptoms, such as gastrointestinal upset, headache, or fatigue?
Does your child have heart disease, kidney disease, diabetes or any auto-immune disorders?
Has your child travelled in the past 14 days to any regions affected by COVID-19 (as relevant to your location)?

Signature of main participant's Parent/Guardian