Jan 24 Modern Class Registration
Circle Modern Dance's modern classes are hosted at the Tennessee Conservatory of Fine Arts (2906 Tazewell Pike, Knoxville TN) from 2:30-4:00 on Sunday. This form is to limit the number of participants to 5 and collect information for contact tracing. Temperatures will also be taken using a non-contact thermometer upon arrival by instructor, as well as cleaning done before and after classes.
* Required
First Name
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Your answer
Last Name
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Your answer
Have you been in close contact with anyone who has a positive Covid-19 diagnosis or has been told to self-isolate for 14 days?
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Yes
No
Are you experiencing a cough, shortness of breath, or difficulty breathing which is new or not explained by a pre-existing condition?
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Yes
No
In the last 48 hours, have you had at least 2 of the following symptoms which are new: fever, chills, fatigure, muscle pain, body aches, headache, sore throat, nasal congestion, vomiting, diarrhea, or loss of taste/smell?
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Yes
No
Is your temperature 100.4 F or higher?
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Yes
No
Email Address
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Your answer
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