Covid 19 Screening Tool for Dance
Parents/Guardians please fill out this form before sending your Student to the Studio. If you answer "YES" to one or more questions, we ask you keep your student home today and attend virtually.
Student Name *
Parent Name *
Contact Number *
A Fever? (Temp. greater than 100.4)
Clear selection
A new or worsening cough?
Clear selection
Shortness of Breath/Difficulty breathing?
Clear selection
Runny nose and/or congestion?
Clear selection
Body Aches and/or tiredness?
Clear selection
Vomiting and/or diarrhea?
Clear selection
New loss of smell or taste?
Clear selection
Sore Throat?
Clear selection
Headache?
Clear selection
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