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EPAA COVID-19 ENTRY CHECK
This form requires completion for all students entering classes with Epworth Performing Arts Academy
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* Indicates required question
Date of Visit
*
MM
/
DD
/
YYYY
Name of Student
*
Your answer
Have you signed and submitted "Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19" (either today or at a previous session)?
*
Yes
No
Has the student washed/sanitised their hands on entry?
*
Yes
No
Does the student have any of these symptoms?
*
Fever
Persistent Cough
Shortness of Breath
Loss of sense of smell or taste?
None of the above
Required
Has the student had contact with people with suspected/diagnosed COVID-19 in the past 14 days?
*
Yes
No
Email Address
Your answer
Contact Phone Number
*
Your answer
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