Covid-19 screening questionnaire

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To be filled before 5 pm on the day of the class.

Student full name( first,middle initial,last name) *

Batch day/time( if multiple days, please indicate all- vocal, harmonium, natyasangeet etc) *

Is the student vaccinated? *

Yes

Are the parents vaccinated? *

Yes

Did the student or any of his/her family members have any Covid-19 related symptoms(ex: fever, sore throat, runny nose, shortness of breath, headache, loss of smell/taste, nausea/vomiting, or diarrhea) in the past 15 days? *

Yes

Any contact with a person who is sick or Covid-19 positive? *

Yes

Any contact with a person who has traveled internationally in the last 15 days? *

Yes

Any travel internationally within the last 2 weeks? *

Yes

Any medical condition that can put the student or parents at increased risk of Covid-19 ? *

Yes

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