Covid-19 Weekly Screening

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Please answer the following questions prior to your dancer's arrival Monday each week

Your Name *

Dancer(s) Name *

Have taken adequate time at home to conduct this health screening of your dancer(s) prior to arrival? *

Yes

Today or in the past 24 hours has your dancer or anyone in your household had any of the following symptoms? If you answer yes to any of the following questions, unfortunately you dancer cannot attend Workshop. *

fever of 100.0 degrees F or higher

cough

sore throat

shortness of breath or difficulty breathing

gastrointestinal symptoms, diarrhea, vomiting, nausea

unexplained rash

unexplained fatigue

new loss of smell or taste

any signs of illness

none of the above - healthy

Required

Have you, your child, or anyone in your household had close contact with someone known to be infected with Covid-19? *

Yes

Has anyone in your household been asked to self-quarantine by a doctor or local health official in the past 14 days? *

Yes

All of this information is true and accurate to the best of my knowledge? *

True

You understand and acknowledge that if you dancer(s) becomes symptomatic, you will be required to pick them up from workshop asap. We ask that you keep us informed of their health in the event that they are sent home or their symptoms change. Dancers must be cleared by a doctor in order to return to our program, as well as be symptom free and fever free without medication or 48 hours. If they show any symptoms, we will keep them isolated from the group and comfortable until your arrival. *

I understand and agree to these terms

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