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Anne Fleming Workshop & Dance - Health & Safety Check-in
Please complete this form prior to attending each class, private lesson, workshop, or event.
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Email
*
Your email
Name:
*
Your answer
Cell Phone:
*
Your answer
Since Jan. 7, have you traveled outside Connecticut or New York?
*
Yes
No
Since Jan. 7, have you attended an event that included
all
of the following:
a) was indoors
b) 100 or more attendees
c) unvaccinated attendees,
and
d) dancing or dining
(Examples: a dance event, cruise ship, wedding, bar/bat mitzvah, holiday party, etc.)
*
Yes
No
Since Jan. 7, have you tested positive for COVID-19 or been in close contact with someone who has COVID-19?
*
Yes
No
If you answered "Yes" to any of the above questions, please provide details below. Additionally, please take a home COVID test and email a picture of the result to Erik@SwingShoes.net
Your answer
A copy of your responses will be emailed to the address you provided.
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