ViBE Dancer Daily Health Screening

Dancer's First and Last Name *

Do you or anyone in your household have 1 or more of these worsening symptoms today or in the last 5 days? (fever, cough, difficulty breathing, decrease or loss of smell or taste) *

No

Yes

Have you or anyone in your household tested positive COVID-19 today or in the last 5 or 10 days? *

No

Yes

Acknowledgement *

I certify that the information submitted in this form is true and correct to the best of my knowledge. I further understand that it is my responsibility to immediately inform ViBE of any changes to the answers I've provided.

Required