COVID-19 Screening

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COVID-19 Screening

This form needs to be completed within 36 hours of coming to the studio for EVERY class/drop in/pick up.

Email *

What is your name? *

I agree to immediately check in with the instructor upon arrival to declare I have done my screening, prior to putting my stuff away or washing my hands. I understand that not doing so may restrict my access to the studio. *

I agree & understand

I have experienced the following symptoms in the past 7 days: fever, dry cough, tiredness, aches and pains, sore throat, diarrhoea, conjunctivitis, headache, loss of taste or smell, rash on skin or discolouration of fingers or toes, difficulty breathing or shortness of breath, chest pain or pressure, loss of speech or movement. *

Yes

I have come into contact with anyone that is has tested positive for COVID-19 within the past 10 days. *

Yes

I have travelled outside of Canada within the last 14 days. *

Yes

I have tested positive for COVID-19 within the past 10 days. *

Yes

If you have answered yes to any of the questions above please email Gabrielle/Melissa at gceramicandco@gmail.com to notify of symptoms and/or exposure so that we can keep our community safe <3 I understand and agree to these conditions. *

Yes

What date are you attending the studio for which you are completing this Screening?

YYYY

A copy of your responses will be emailed to the address you provided.

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