Health + Safety Pledge Winter '21
(REVISED 1/1/21) This form must be completed EACH TIME you attend any in-person Groove class or event either indoors or outdoors. By checking the box next to each safety measure, you are acknowledging and agreeing to these guidelines. Thank you in advance for your compliance with and enforcement of these important health guidelines.
May we reach out to you by text? If yes, please provide best reach number(s)
DATE of your upcoming Groove class or event.
Names of all those attending
PRE-CLASS PROTOCOL: Please confirm the following for all attendees AND members of their extended families:
No signs of illness (cough, shortness of breath, fever, etc) or confirmed Covid-19
No known exposure to anyone with signs of illness or confirmed Covid-19
No body temperature 100 degrees or above
No travel within the last 14 days to a state requiring a NYS quarantine
Not in quarantine for exposure to covid-19
PROTOCOLS DURING CLASS: All attendees will adhere to the following safety measures:
Grown-up will be fully responsible for child before, during and after class
Masks or face guards will be worn at ALL times by everyone aged 2 years and older
Maintain a distance of at least 6 ft between ourselves and others
Arrive only 5 minutes prior to class time to minimize exposure
Non-registered siblings (9 months and older) may not attend with registered child
Additional grown-ups (partner, grandparent, etc) may attend only with prior permission
POST CLASS PROTOCOL: If attendee or attendee's family member is diagnosed with Covid-19 and/or quarantining due to exposure to Covid-19, DO NOT attend class and please notify Groove Family Music (914-834-3383) as soon as possible. Your identity will be kept strictly confidential. Thank you!
I agree to these terms
Please err on the side of caution out of consideration for your fellow music makers! If you have questions, comments or concerns, please leave a note below or email
. Thank you!
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