Youth Program Holiday Show n' Glow Pre-Screening Form

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Entry will be denied to any person who answers "Yes" to one or more of the following questions. This form must be filled out EACH VISIT to the studio and on the SAME DAY as the visit. Forms must be submitted by a parent or guardian.

Is your child's in-studio class today? *

1 point

Yes

No (STOP filling this form if your child's class is not today)

What is your child's name? *

First and last name as shown on their registration form

Does your child have any of the following new or worsening symptoms? *

Symptoms should not be chronic or attributed to a diagnosed condition.

1 point

Fever and/or chills?

Cough

Sore Throat

Shortness of breath

Decrease or loss of sense of taste or smell

Muscle aches/joint pain

Nausea/vomiting, diarrhea, abdominal pain

Extreme tiredness

Runny and/or congested nose

Headache

None of the above

Required

Has your child taken any medication for the purpose of fever reduction in the 8 hours prior to dance class arrival time

1 point

Yes

Clear selection

Has your child been exposed to anyone in the last 10 days (in the household or out of the household) who has tested positive for covid-19 on a rapid antigen test or pcr test? *

1 point

Yes

Has your child travelled outside of Canada in the past 14 days? If they have but are exempt from quarantine, please select "No" *

1 point

Yes

Has your child or anyone in your household been directed to isolate (including for travel reasons)? *

1 point

Yes

Has your child tested positive on a rapid antigen test or pcr test in the past 10 days? *

1 point

Yes

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