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COVID-19 REPORTING FORM:
Please complete to report COVID-19 exposure or testing.
* Indicates required question
Email
*
Your email
Child's Name:
*
Your answer
Parent/Guardian Name:
*
Your answer
Parent/Guardian Email
*
Your answer
Parent/Guardian Phone Number:
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Your answer
Have you or someone in your household been exposed to COVID-19?
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Yes
No
Maybe
Date of Exposure:
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MM
/
DD
/
YYYY
Late date your dancer was at Dancer's Edge Studios:
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MM
/
DD
/
YYYY
Please explain circumstances of the exposure (how, when, what, who):
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Your answer
Have you or someone in your household been tested for COVID-19?
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Yes
No
Please explain your test results:
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No test has been conducted
My dancer has been tested and is waiting on results
One or more of my family members have been tested and are waiting on results
Results have been received and are negative for my dancer
Results have been received and are negative for one or more of my family members
Results have been received and are positive for my dancer
Results have been received and are positive for one or more of my family members
Other:
In reference to the initial person who exposed your family to COVID-19, did that person have symptoms the immediate two days prior to testing?
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yes
no
In reference to the initial person who exposed your family to COVID-19, did that person have symptoms after being tested?
*
yes
no
Does anyone in your household currently have symptoms or have had symptoms since exposure?
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yes
no
Any additional comments or information that we need to know?
*
Your answer
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