COVID Screening Form 2021-2022 Dance Season

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Parents must complete this form prior to their child attending dance class. The form only needs to be completed once in September, January and March. Parents are then also required to self-screen their child before EACH class for the rest of the season. If the student is experiencing ANY symptoms of COVID-19 they must stay home from dance and should seek testing and appropriate medical attention. If you are ill or not feeling well, please stay home. If any of your answers change, please advise the studio.

COVID-19 vaccine side effects - Dancers may attend class if they or anyone in your household got a COVID-19 vaccine in the last 48 hours and is experiencing any of these symptoms that are mild and only began after vaccination: headache, fatigue (extreme tiredness), muscle aches or joint pain

**** PER HAMILTON BY-LAW 20-155 ALL STUDENTS, STAFF AND VISITORS TO OUR STUDIO MUST WEAR A FACE MASK WHEN COMING IN TO OUR STUDIO. YOU WILL BE DENIED ENTRY INTO THE STUDIO IF YOU DO NOT HAVE A FACE MASK. *****

Please wait in the designated line up are in the parking lot (along the wall). Staff will post on the front door once they are accepting entrance for your child's class and will screen dancers by checking their temperature and hand sanitize upon entry.

Dancer's First and Last Name *

Does your child have any of the following symptoms? *

Fever and/or chills

Cough or barking cough (croup)

Shortness of breath

Decrease or loss of taste or smell

Nausea, vomiting, and/or diarrhea

None of the Above

Does the dancer have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19? *

Yes

Is the dancer or someone that the dancer lives with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

Yes

Clear selection

Did the dancer travel outside of Ontario in the past 14 days? (Can answer no if travel was completed, BUT the dancer is DOUBLE VACCINATED at least 2 weeks prior to travelling). *

Yes

Has a doctor, health care provider, or public health unit told you that the dancer should currently be isolating (staying at home)? *

Yes

Is the dancer willing to wear a mask when entering/exiting the studio (over 2 years old only), having their temperature taken before entering the studio and wash/sanitize their hands before and after class? *

Yes / dancer is under 2 years old

Has the dancer received 2 doses of COVID-19 vaccination at least 2 weeks prior to attending classes? If yes, please submit your proof of vaccination to amanda@notjustanotherdancesstudio.ca and put subject = vaccination proof *

Yes

Not applicable, the dancer is 11 years old or younger

Students and instructors will be socially distanced by 6 feet or more during class. I hereby authorize NJADS Instructors to enter this social distancing barrier to make corrections to my child during dance class. (i.e. contact to correct to posture, position, technique or to spot during acro class). Both student and instructor must wear their mask if within 6 feet, and hand sanitizer must be used before and after contact has been made. *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms