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POW! REGISTRATION Friday Dance 5 PM Program RSVP
Greenpoint, Brooklyn. Entrance corner of Manhattan Ave/1006 Street. G-train Greenpt. Ave, exit India street.
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Email
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Your email
Names & age/s of kids attending POW!: Date attending:
*
Your answer
I am a volunteer
Yes
How can we best support your kid during our programs? Is there a diagnosis we should know about?
Your answer
Name/s of guardian/ parent/s
*
Your answer
In the last 48 hours, have you/your child(ren) experienced any of the following symptoms?
*
Fever (over 100.0 °F)
Headache
Cough
Sore throat
Shortness of breath
Chills
Muscle aches
Loss of taste and smell
Gastrointestinal (nausea, vomiting or diarrhea)
Yes
No
In the last 14 days, has anyone in your household had close contact with someone who has or is suspected to have COVID-19?
*
Yes
No
Please wear a high quality mask and keep a safe distance
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Yes, we will wear a Mask
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