FGC Safety First Partnership Agreement & Assumption of Risk: Entry Survey
This Safety First Partnership Agreement is for the safety and protection of staff, students, and their families at Flying Gravity Circus. As an FGC Participant, you agree to complete this survey each time you attend an FGC class or event.

I and/or my child will honestly answer the questions below.
Student's Name (First, Last) *
What FGC group are you part of? *
Are you and/or your child currently experiencing any of these symptoms of possible COVID-19 as listed by the CDC? *
No
Yes
Fever (100.4 degrees F or higher) or feeling feverish
Runny nose, nasal congestion, or sore throat
Cough, shortness of breath, or difficulty breathing
Chills, or repeated shaking with chills
Muscle pain or body aches (of unknown cause)
Headache
New loss of taste or smell
Diarrhea
Symptoms associated with Multi-System Inflammatory Syndrome in children, including persistent fever (4-5 days), rash, and/or abdominal pain
Within the past 14 days, have you and/or your child: *
No
Yes
Been in close contact with anyone who has tested positive for COVID-19?
Traveled by airplane domestically or internationally?
Traveled to an area with known community-wide spread?
I and/or my child have worn a protective mask in all public situations where physical distancing of 6' was not consistently possible. *
I understand I and/or my child could be an asymptomatic carrier of COVID-19 and could unknowingly spread the virus to others. *
I understand I and/or my child could contract COVID-19 from an asymptomatic person or contaminated surface at FGC. *
I am fully aware of the FGC's FGC Reopening Plan & Pandemic Procedures posted at www.flyinggravitycircus.org/covid-19-response to reduce the risk of spreading of COVID-19, and I (and my child if I have a child in the program) will follow those procedures. *
I will inform Flying Gravity Circus immediately if any of the above information changes, if I and/or my child develop symptoms within 14 days of being in the studio, or if I learn that I and/or my child have been in direct contact with someone who has tested positive for COVID-19 within the same 14 day period. *
I understand that if I willfully and intentionally violate any of FGC's Pandemic Procedures, FGC has the right to suspend me and/or my child without a refund. *
I allow FGC staff to take my and/or my child's temperature prior to classes or events. *
Temperature reading* (Please take if you are able, otherwise LEAVE BLANK-to be filled out by staff at the studio)
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