MSTDA PRE-CLASS HEALTH SCREENING
Prior to attending class or rehearsal at Main Street Theatre & Dance Alliance, we ask that you complete the health screening questionnaire below. If you answer "yes" to any of the below questions or are experiencing any of the symptoms listed, please notify us and do not attend class or rehearsal.
Email address *
Student Name *
Please enter the date of your class. *
MM
/
DD
/
YYYY
Class type attending today: *
Have you or anyone in your household tested positive for COVID-19 in the past 14 days? *
Have you or any members of your family been exposed to someone who has tested positive for COVID-19 in the past 14 days? *
Have you or any members of your family traveled in the past 14 days to an area considered a hot zone for COVID-19? Areas on the travel advisory can be found here - https://coronavirus.health.ny.gov/covid-19-travel-advisory *
Have you, anyone in your family, or your child experienced any of the following symptoms in the past 48 hours? *
Required
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy