Summer Workshop Registration

	DD/MM/YYYY

	No	Mild	Severe
Fever – temperature 100.0 F or higher (please do a temperature check the morning of your visit.)	Fever – temperature 100.0 F or higher (please do a temperature check the morning of your visit.) No	Fever – temperature 100.0 F or higher (please do a temperature check the morning of your visit.) Mild	Fever – temperature 100.0 F or higher (please do a temperature check the morning of your visit.) Severe
Chills	Chills No	Chills Mild	Chills Severe
Cough	Cough No	Cough Mild	Cough Severe
Shortness of breath	Shortness of breath No	Shortness of breath Mild	Shortness of breath Severe
Fatigue	Fatigue No	Fatigue Mild	Fatigue Severe
Muscle or body aches	Muscle or body aches No	Muscle or body aches Mild	Muscle or body aches Severe
Headache	Headache No	Headache Mild	Headache Severe
New loss of taste or smell	New loss of taste or smell No	New loss of taste or smell Mild	New loss of taste or smell Severe
Sore throat	Sore throat No	Sore throat Mild	Sore throat Severe
Congestion or runny nose	Congestion or runny nose No	Congestion or runny nose Mild	Congestion or runny nose Severe
Nausea or vomiting	Nausea or vomiting No	Nausea or vomiting Mild	Nausea or vomiting Severe
Diarrhea	Diarrhea No	Diarrhea Mild	Diarrhea Severe