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COVID-19 Health Declaration
This survey is MANDATORY for all students to fill out within 30 minutes of the start of each class.
If the answer to any of these questions is not “Yes” please contact your instructor to discuss if it is safe for you to attend class, or email
info@phoenixdanceandfitness.com
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Date of class
*
MM
/
DD
/
YYYY
Class Attending
*
Your answer
My body temperature is BELOW than 100 °F/ 37.8 °C
*
Yes
No
If “No” please explain.
Your answer
I have NOT experienced ANY of these symptoms in the last 24 hours: fever, dry cough, sore throat, chills, shortness of breath, loss of smell or taste. And I have NOT tested positive for COVID-19 in the last 14 days.
*
Yes
No
If “No” please explain.
Your answer
I have NOT been in close contact with anyone displaying any of the above symptoms or anyone who has tested positive for COVID-19 in 14 days.
*
Yes
No
If “No” please explain.
Your answer
I declare my presence in class will NOT pose a health risk to others and that I've completed this survey honestly and accurately
*
Yes
No
If “No” please explain.
Your answer
I have NOT travelled outside of the area in the last 14 days or attended any large gatherings.
*
Yes
No
If “No” please explain.
Your answer
Please remember to bring all items needed for class including cleaning supplies for your apparatus, a towel, and something to clean your yoga and/or crash mats. Cleaning supplies will be on sale in our merchandise if you do forget. Thank you for attending class at Phoenix Fitness & Dance.
Please contact us at
info@phoenixfitnessanddance.com
if you have any questions.
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