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. www.urbanmovementarts.com
Email address *
Please confirm today's date: *
MM
/
DD
/
YYYY
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.* *
Required
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. *
Required
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. *
Submit
Never submit passwords through Google Forms.
This form was created inside of Urban Movement Arts. Report Abuse