Child's Name *

First Name

Last Name

How are you feeling? *

Excited

Fine, thank you.

Okay

Nervous

A wreck

Other

Sibling(s)

At a setting with mask mandates

At a mask-optional setting

At home with a parent or caregiver

No sibling

Other

When would you like to reassess these current protocols? *

Two weeks

Four weeks

At a certain threshold that I will describe below

Other