COVID-19 Screening Form ~ Whitby Dance Company Ltd.
We require this form to be filled out prior to anyone entering the building for Dance Classes or otherwise for COVID-19 Tracking.
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#1 - Full Name (of dancer or person entering Whitby Dance Company)
#2 - Phone Number (for all non-staff)
#3 Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days?
#4 Have you returned from travel outside Canada in the past 14 days?
#5 Does your child have any of the following symptoms:
New onset of cough
Worsening chronic cough
Shortness of breath
Decrease or loss of sense of taste or smell
Unexplained fatigue/malaise/muscle aches
Pink Eye (conjunctivitis)
Runny nose/nasal congestion without other known cause
None of the above
#6 Have you reviewed our new policies and dance safe procedures? Please visit our website:
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