Covid-19 Safety Check-in Original

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Answer questions honestly and to the best of your ability (or on your child's behalf) each time you come to an open gym, class, etc:

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Email *

Who is filling out this form? Kalani wilson *

Have you experienced an unexplained onset of any of the following symptoms of COVID-19 listed below in the last 2 weeks (unrelated to chronic or pre-existing conditions)? The CDC list includes: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose (unrelated to seasonal allergies), nausea or vomiting, diarrhea. (If you answered yes to this question and want to talk with us about whether you can come into open gym/class, please contact Jake at 203-843-7444 or 865-609-2012. He is a registered nurse and will talk with you about your experience.) *

Yes

Have you been in contact with anyone with COVID-19 or anyone with symptoms from the CDC list above in the last 2 weeks? *

Yes

Will you immediately inform Dragonfly Aerial & Circus Arts studio if you develop any of the abovementioned symptoms within 2 weeks of being in the studio or learn that you have been in contact with someone who has later tested positive for COVID-19 within the same time frame? *

Yes

Do you understand that you could be an asymptomatic carrier of the virus? *

Yes

Have you been following the 5 core practices as outlined by the City of Knoxville? (Wash your hands, practice physical distancing, wear face masks, sanitize surfaces, stay home when sick) *

Yes

Have you read Dragonfly's new open gym protocols and guidelines and agree to adhere to them? https://www.dragonflyaerialartsstudio.com/covid-19.html *

Yes

Do you understand that if you deliberately violate the new open gym protocols and guidelines, you will be suspended from the studio without a refund? *

Yes

If you develop symptoms after you book or the morning of your booked class, do you promise to inform us ASAP by calling (865) 609-2012? *

Yes

Do you have any respiratory conditions (ie, asthma) or heart issues that we should know about? Since masks are required in the studio, we want open gym hosts and instructors to be aware of those who may need to take more frequent breaks outside to take a mask break or work at a more reserved pace. *

Yes

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