RAB and Dance - COVID - 19 Questionnaire

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Please read and answer the questions below. If you answer yes to any of these questions please stay home and let us know that you are not able to teach.

In the past 24 hours have you experienced a fever? *

Yes

In the past 24 hours have you experienced a new or worsening cough? *

Yes

In the past 24 hours have you experienced shortness of breath or trouble breathing? *

Yes

In the past 24 hours have you experienced a sore throat that is different that seasonal allergies? *

Yes

In the past 24 hours have you experienced new loss of smell or taste? *

Yes

In the past 24 hours have you experienced diarrhea or vomiting? *

Yes

In the past 14 Days have you traveled out of the state of NY to any of the "Hot Spot" state listed NYS Travel Advisory page (https://coronavirus.health.ny.gov/covid-19-travel-advisory) *

Yes

If you answered yes to the Travel Advisory question, have you completed your 14 day quarantine and are symptom free? *

Yes

Scanned Temperature (completed at the studio and logged)

By typing your name and submitting this form you agree that this constitutes your electronic signature and that you have read and agree that all your answers are correct. *

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