ViBE Dancer Daily Health Screening
Dancer's First and Last Name *
Parent/Guardian First and Last Name *
Has the dancer had contact with anyone who travelled outside of Canada over the last 14 days? *
Has the dancer tested positive or been in close contact with anyone who has tested positive for COVID 19? *
Is the dancer, or someone in their household, awaiting COVID 19 test results? *
Does the dancer have a new or worsening cough, shortness of breath or difficulty breathing? *
Does the dancer have a throat sore or difficulty swallowing? *
Does the dancer have chills? *
Does the dancer have a headache? *
Does the dancer have unexplained muscle aches? *
Does the dancer have a runny nose or nasal congestion unrelated to allergies? *
Does the dancer have a decrease or loss in sense of taste or smell? *
Is the dancer experiencing nausea/vomiting, abdominal pain, or diarrhea? *
Does the dancer feel extremely tired, fatigued, and lack of energy? *
Acknowledgement *
Required
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