COVID 19 Self Health Assessment
Please complete and submit the follow self health assessment before registering for any in person (outdoor or in studio) classes. If there is a box you cannot check, please do not come to class; visit our homepage for other resources.
Please confirm today's date:
Enter your full legal name.
Have you read our Pandemic Protection Rules & Guidelines? A link and downloadable PDF can be found on our website homepage.
CHCECK the BOX to CONFIRM that you do NOT have any of the symptoms listed. *If you have experienced any of the symptoms listed within the last 14 days, please quarantine and do not come to in person classes.*
loss of smell or taste
shortness of breath
diarrhea or nausea
congestion or runny nose
I have NOT been in contact with anyone who has tested positive for COVID 19 within the last 14 days.
I have NOT flown on a commercial airline in the last 14 days.
I understand I may be asked to leave class if I exhibit any of the above listed symptoms. I understand there are no returns or exchanges for in person classes.
I have signed the waiver via MindBody releasing UMA/MoveMakers of all liability. If not, please log into your MindBody account to sign our waiver, updated as of August 2020.
By entering your initials below, you confirm you have read and complete all of the questions above and agree to abide by all of UMA's COVID 19 protocol.
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This form was created inside of Urban Movement Arts.