Studio 5.6.7.8 COVID Screening Form 2021
At Studio 5.6.7.8 Inc, our top priority is the health and safety of our dancers!

Please fill out this form for your child on the day of their class prior to arriving at the studio. The screening form must be completed everyday that your child attends class at the studio. If you are showing any symptoms, or answer yes to any Y/N questions, please stay home and follow the guidance of a health care provider.
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Name of dancer
Date of Class:
MM
/
DD
/
YYYY
Are you experiencing any of the following symptoms?
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
Clear selection
In the last 14 days , have you travelled outside Canada? *
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *
Submit
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