Spencer Nyemchek's School of Ballroom Dance COVID-19 Pre Screening Form
This form is for anyone who wishes to enter our studio building. If you are answering this form for a minor and also plan on entering our studio building, we will send you a second form to fill out. Please answer all questions honestly and to the best of your knowledge.
Email *
Name *
Contact Phone Number *
Do you or have you had a fever of above 100 degrees in the past three days? *
Have you recently lost or had a reduction in your senses of smell or taste? *
Do you have a sore throat? *
Do you have a dry cough? *
Do you have a runny nose? *
Have you been in contact with someone who has tested positive for or suspected they were positive for Covid-19 (corona virus?) in the last two weeks? *
Have you tested positive for Covid-19 or are you awaiting test results for Covid-19 within the last 10 days? *
If you have answered "Yes" to any of the previous questions, we may or may not grant you access to our studio until further investigative measures have been completed.
We want to thank you for your cooperation in keeping our dance family safe! We love you and cannot wait to dance with you again!

All our love,

Spencer and Elena Nyemchek
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