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? *

Yes

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? *

Yes

3. Have you exhibited any suspected symptoms of COVID-19, such as fever and cough, within the last 14 days? *

Yes

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? *

YES

Have you traveled outside of the US in the last 30 days? *

Yes

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? *

Yes

Have you been FULLY vaccinated from COVID-19 by one of the FDA approved Vaccines? *

Yes

Thank you!

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