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Aidan Montessori School Family Event Questionnaire (Elementary Musical - June 3)
Please provide us with this information within 48 hours of attending any in-person events.
We are required to keep this information on file for 30 days for the DC Department of Health in case there is a breakout of COVID-19 at an event.
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* Indicates required question
Family Members Attending - First & Last Names
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Event Date (6/3/2022)
*
MM
/
DD
/
YYYY
In the last 72 hours, have any attending family members experienced any of the following new or unexplained symptoms:
*
Fever of 100.4℉ or higher, chills
Shortness of breath, difficulty breathing, an uncontrolled cough, severe headache
Nausea, vomiting, diarrhea
New loss of taste or smell
Muscle/body aches, fatigue
Sore throat, congestion, runny nose
None of the above
Required
In the last 10 days, have any of the unvaccinated attendees in your family traveled outside of the DMV and not received a COVID-19 test 3-5 days after their return?
*
Yes
No
In the last 10 days, have any listed family members, that are unvaccinated, been in close contact (within 6 feet or less, for more than 15 minutes, over a 24 hour timeframe) with a person who has tested positive for COVID-19?
*
Yes
No
Yes, but they have tested negative 5-7 days after their last exposure and understand that they must properly wear a mask for the entirety of the event
Are any family members currently awaiting the results of a COVID-19 test?
*
Yes
No
Have any family members tested positive for COVID-19 in the past 10 days?
*
Yes
No
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