K.S. J.A.M.M. Dance Troupe Pre-Entry Health Screen
All persons entering K.S. J.A.M.M. Dance Troupe MUST go through a pre-screening:
* All persons MUST have a temperature check before entry
* All persons MUST wear a face mask before and upon entry
* All persons MUST wear a mask for the duration of their time in the studio
* All persons MUST complete an Entry Health Screen before every visit
* ALL persons MUST sign a Release and Waiver of Liability, Assumption of Risk; And Indemnity Agreement
* ALL EXITS are FINAL for every visit
* ALL children under the age of 18 MUST have their parent/guardian complete the Pre-Entry Health Screen
Student's First Name, Student's Last Name, Student's Age
Parent's First Name, Parent's Last Name, Parent's Cell/Contact Number (If applicable, write N/A if it does not apply)
Do you have any of these symptoms that are not caused by another condition?
Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
Recentloss of taste or smell
Nausea or vomiting
NONE OF THE ABOVE
Within the past 14 days, have you had contact with anyone that you know hadCOVID-19or COVID-like symptoms? Contact is being 6 feet (2 meters)or closerfor more than 15minutes with a person, or havingdirect contact with fluidsfrom a person with COVID-19(for example,being coughed or sneezed on).
Have you had a positive COVID-19test for active virus in the past 10 days?
Within the past 14 days, has a public health or medical professional told you to self-monitor,self-isolate, or self-quarantine because of concerns about COVID-19 infection?
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This form was created inside of K.S. J.A.M.M. Dance Troupe.