Richlands Regional Camp Meeting : Richlands SDA Church Cherryville BC

Name

Email

Phone

Name & Age of Campers (including yourself)

List Allergies (if any)

Do you have a fever?

Yes No

Do you have any of the following signs or symptoms?

Have you traveled or had close contact with anyone who has traveled in the past 14 days?

Yes No

Have you had close contact with anyone with respiratory illness or a confirmed or probable/suspected case of COVID-19?

Yes No