COVID-19 Pre-screening Questionnaire
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Email *
Address (for contact tracing purposes) *
Please enter your zip code. *
First Name *
Last Name *
Phone Number *
1. Have you tested positive for COVID-19 anytime within the last 14 days? *
2. Have you been in contact with anyone who has tested positive for COVID-19 or has been in close or proximate contact with a confirmed or suspected COVID-19 case in the past 14 days? *
3. Have you exhibited any suspected symptoms of COVID-19, such as fever and cough, within the last 14 days? *
Do you have any issues or health concerns that may inhibit you breathing with a mask or wearing a mask at ALL TIMES - including when dancing or performing a physical activity? *
Have you traveled outside of the US in the last 30 days? *
5. Do you affirm that you are practicing all mandated and recommended health measures, including proper and frequent hand washing/cleaning, wearing face coverings and maintaining social distance? *
Have you been FULLY vaccinated from COVID-19 by one of the FDA approved Vaccines? *
Thank you!
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