COVID-19 REPORTING FORM:
Please complete to report COVID-19 exposure or testing.
Email address *
Child's Name: *
Parent/Guardian Name: *
Parent/Guardian Email *
Parent/Guardian Phone Number: *
Have you or someone in your household been exposed to COVID-19? *
Date of Exposure: *
MM
/
DD
/
YYYY
Late date your dancer was at Dancer's Edge Studios: *
MM
/
DD
/
YYYY
Please explain circumstances of the exposure (how, when, what, who): *
Have you or someone in your household been tested for COVID-19? *
Please explain your test results: *
In reference to the initial person who exposed your family to COVID-19, did that person have symptoms the immediate two days prior to testing? *
In reference to the initial person who exposed your family to COVID-19, did that person have symptoms after being tested? *
Does anyone in your household currently have symptoms or have had symptoms since exposure? *
Any additional comments or information that we need to know? *
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