Theater and Dance COVID-19 Compliance Form

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Theater and Dance asks that you complete this compliance form BEFORE coming to any performances. You may be asked to show proof of completion upon arrival to the venue.

What is your email address (COVID tracing purposes)? *

Have you had any of the following CDC COVID-19 symptoms in the last 24 hours, that are new, unexpected and not related to pre-existing conditions? *

fever or chills

cough

new loss of taste or smell

diarrhea

muscle or body aches

headache

sore throat

congestion or runny nose

nausea or vomiting

fatigue

shortness of breath or difficulty breathing

NONE OF THE ABOVE

Required

Within the past 10 days, have you been diagnosed with COVID-19, but have not yet completed the isolation period recommended by your healthcare provider? *

yes

Within the past 10 days, have you been in direct close contact with anyone known or suspected to have COVID-19 (does not apply to healthcare personnel)? *

yes

If you've recently returned from travel to another country within the last 10 days, are you still within the required quarantine period of 7 or 10 days? *

yes

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