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On Stage Dance Studio Health Screening
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* Indicates required question
Child's Name
*
Your answer
Parent/Guardian name
*
Your answer
Today's date
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Do you/your child have any of the following symptoms that are new or worsening? Fever, cough, shortness of breath, loss of taste/smell, fatigue, nausea, diarrhea. Symptoms should not be chronic or related to other known causes or conditions.
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Yes
No
Required
Has a doctor, health care provider, public health unit, or federal quarantine requirements told you to isolate? This could be due to travel, close contact, Covid Alert notification, etc.
*
Yes
No
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