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ViBE Dancer Daily Health Screening
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* Indicates required question
Dancer's First and Last Name
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Your answer
Parent/Guardian First and Last Name
*
Your answer
In the past 14 days, has the dancer tested positive or been in close contact with anyone who has tested positive for COVID 19?
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No
Yes
Do you have any of the following symptoms or conditions: fever, cough, nausea, vomiting, extreme tiredness, shortness of breath, difficulty breathing, and/or sore throat unrelated to allergies?
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No
Yes
Acknowledgement
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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.
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