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COVID-19 PRE-SCREENING
Must be completed by dancers, staff & parents upon arrival, before entry into the studio
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* Indicates required question
Email
*
Your email
Dancer/Faculty Name:
*
Your answer
Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.
*
YES
NO
Fever
Difficulty Breathing
New or Worsening Cough
Sore throat, trouble swallowing
Runny/Stuff Nose or Nasal Congestion
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Not feeling well, extreme tiredness, sore muscles
YES
NO
Fever
Difficulty Breathing
New or Worsening Cough
Sore throat, trouble swallowing
Runny/Stuff Nose or Nasal Congestion
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Not feeling well, extreme tiredness, sore muscles
Have you travelled outside of Canada in the past 14 days?
*
YES
NO
Have you come into close contact with a confirmed or probable, positive case of COVID-19?
*
YES
NO
A copy of your responses will be emailed to the address you provided.
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