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Village of Rye Brook
Paving Notice - Updated 6/29/2022
Travel Camp Questionnaire Form
Name
*
Required
Date
*
Required
Email Address
*
Required
Phone Number
*
Required
Does your child have a temperature of 100.00 degrees Fahrenheit or higher?
*
Required
Yes
No
Does your child feel feverish or are they experiencing chills or symptoms of a lower respiratory illness such as cough, shortness of breath or difficulty breathing?
*
Required
Yes
No
Has your child traveled to an area with known local or international spread of Covid-19 in the past 10 days?
*
Required
Yes
No
Has your child come into contact in your residence (within 6 feet) with someone who has a suspected or confirmed case of Covid-19 diagnosis in the past 10 days?
*
Required
Yes
No
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