Cadance Jazz & Pilates - COVID-19
Personal information – So we can provide you with the best possible care and service, we ask that you carefully fill out the requested information. This information is kept strictly confidential and will be accessed by only your teacher(s).
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Student declaration before a class with Rachel Santos of Cadance Jazz & Pilates.
3429 rue Notre-Dame Ouest, Montreal, QC H4C 1P3
First and Last Name *
I am prepared to show my vaccine passport to Cadance/Universal Dance Studio staff, along with a photo ID, to gain admittance to the studio. *
Required
I hereby declare that I DO NOT have any of these symptoms:
By checking the box next to the description, you declare that you are not experiencing that symptom. If you cannot check all of the boxes, please do not come into the studio. We can reschedule or complete your session online without penalty. The health and safety of all of my students are my priority.
Fever (> 38°C) *
Required
Recent cough *
Required
Chronic exacerbated cough *
Required
Respiratory difficulty *
Required
Sudden loss of smell without nasal congestion with or without loss of taste *
Required
Muscle pain *
Required
Headache *
Required
Intense or severe fatigue *
Required
Loss of appetite *
Required
Sore throat or diarrhea *
Required
I declare that in the last 14 days, I have not been in close (less than 2 meters) and prolonged (15 minutes or more) contact with a person diagnosed or suspected to have contracted COVID-19 or any of the symptoms mentioned above. *
Required
I declare that I have not traveled outside of Canada in the last 14 days. ***OR if I have traveled outside of Canada in the last 14 days, I can provide proof of a negative Covid test (see below) taken within 72 hours of the scheduled departure time of my flight back to Canada. *
Required
Rapid antigen tests will not be accepted. Accepted types of molecular tests: PCR - Polymerase chain reaction; Nucleic acid test (NAT) or Nucleic acid amplification test (NAATs); Reverse transcription loop-mediated isothermal amplification (RT-LAMP). These tests use methods such as a nasopharyngeal (NP) swab, nose swab, or saliva sample. Monitor for symptoms for at least 14 days after your arrival.
Please see here for other acceptable types of tests and for more info: https://travel.gc.ca/travel-covid/travel-restrictions/covid-vaccinated-travellers-entering-canada#entry-vaccinated
I agree to respect the hygiene and social distancing measures in place concerning COVID-19 throughout the class (following proper hand-washing procedures in the studio before and after my session, wearing a mask for the duration of my time inside the studio, etc.). *
Required
If you are unable to check any of the boxes due to having any of the aforementioned symptoms, please return home and contact the INFO-COVID line at 1-877-644-4545 to find out what to do before returning to the studio. Thank you.
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