Covid-19 Pre-Screening Questionnaire

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This form must be completed and submitted prior to a student arriving at the studio. Thank you.

Email *

Student (s) Full Name (s) *

*Do you or your child exhibit any of the following symptoms: Fever, Cough, Shortness of Breath, Sore Throat, Difficulty Swallowing, Loss of Taste or Smell, Nausea/Vomiting/Diarrhea/Abdominal Pain, Runny Nose or Nasal Congestion (non-seasonal), Rash? *Have you travelled outside Canada in the last 14 days or to an area considered high risk within Canada? *Have you tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 in the last 14 days? *

Yes

Should I develop symptoms and/or test positive for COVID-19 and/or come into close contact with someone with a confirmed case of COVID -19, I will notify Art & You and I waive Art & You, its owners, managers and teachers from any fault or responsibility. *

Yes

Required

Please type your full name on behalf of your child(ren) if they are under 18 years of age. *

Today's Date *

YYYY

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