Liezel Marais Dance Academy COVID-19 Risk Assessment Form
Questionnaire for students/dancers before arriving for in-person lessons at the studio. *To be completed before every in-person lesson.*
Name and Surname of student/dancer
Are you currently experiencing any of the following symptoms? (Do not send any student/dancer to class if he/she presents any of the following associated symptoms.)
Fever (temperature above 38°C)
Shortness of breath
Loss of taste/smell
None of the above
Have you or any direct family member tested positive or awaiting results for COVID-19 in the past 14 days?
Have you or any direct family member come into close contact with someone who is awaiting results or tested positive for COVID-19 in the past 14 days?
I confirm that the above information is correct and answered to the best of my knowledge.
Please remember to complete a new form before every in-person lesson at the studio! Thank you for your co-operation to protect and safeguard our dance family.
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