COVID WAIVER CHECK
Getting you back to community. Complete a daily health check to keep you and your community safe. You must fill out before you enter the studio for practice.
Email address *
Full Name *
Have you tested positive for COVID-19 in the past 14 days? *
Have you travelled to a known "hotspot" or restricted state as documented by the Public Health Authority in the last 14 days? *
Have you had a new or worsening cough within the last 14 days? *
Have you had difficulty breathing or shortness of breath within the last 14 days? *
Have you had a sore throat or persistent cough within the last 14 days? *
Have you experienced headaches, body aches, chills, or fatigue within the last 14 days? *
Have you experienced abdominal pain, nausea/vomiting, or diarrhea within the last 14 days? *
Within the last 14 days, have you comin in contact with a person with a confirmed or suspected case of COVID-19? *
Do you feel feverish or do you have a body temperature greater than 100.4° F (38° C)? (You will be temperature check when you enter.) *
Enter Initials before submitting *
date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy