COVID-19 Screening Form for Four Seasons Dancers Volunteers
Please fill out this form and submit the same day you volunteer.  If you are sick or have symptoms of illness, stay home.  Please stay home regardless of your illness.

As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following guidance from the Centers for Disease Control and Prevention and local health authorities. In order to prevent the spread of the coronavirus and reduce the potential risk of exposure, all volunteers and attendees are required to complete and submit this questionnaire.

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Email *
Today's Date *
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Parent/Guardian Name *
Volunteer's Name *
Best Contact Number *
The volunteer has NOT had a temperature greater than 100.4 degrees over the past 24 hours? *
Required
The volunteer has NOT had a documented case of COVID-19 in the last 14 days? *
Required
The volunteer has NOT had any close contact with an individual who has had any symptoms related to COVID-19 or anyone with a confirmed case of COVID-19? *
Required
The volunteer is currently NOT demonstrating or suffering from any illness with symptoms such as coughing, shortness of breath, sore throat, congestion, nausea and vomiting, diarrhea, headache, muscle, joint pain, sudden loss of taste or smell, or chills? *
Required
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