BABY PIANO - Covid- 19 Daily Pre-Class Assessment
BABY PIANO - Covid- 19 Daily Pre-Class Assessment
This form is for all attendees of the Baby Piano CAMP in 2021

*THIS FORM SHOULD ONLY BE COMPLETED WITHIN 5 HOURS OF START OF CAMP. ENTRIES GREATER THAN 5 HOURS BEFORE THE TRAINING SESSION ARE DEEMED INVALID.*

Please fill out the following assessment daily prior to arrival to camp. This assessment should not be completed on-site and the student will not be able to attend camp without completion of this assessment. This assessment will assess whether the student is experiencing Covid-19 related symptoms and their eligibility to participate in class. Please answer all questions truthfully and to the best of your knowledge.
Guardian Name *
Email *
Contact Number *
Student Name *
Is the student experiencing any of the following symptoms: fever, cough, shortness of breath, trouble swallowing, runny/stuffy nose or nasal congestion? *
1 point
Is the student experiencing nausea, vomiting, diarrhea, abdominal pain or general feelings of tiredness, sore muscles, or not feeling well? *
1 point
Is the student experiencing cold or flu-like symptoms (fever, dry cough, difficulty breathing, respiratory illness, decrease/loss of smell) in the last 14 days? *
1 point
Has the student, or anyone in your household, traveled outside of Canada in the last 14 days? *
1 point
Has the student, or anyone in your household, been in contact in the last 14 days with a person who is in isolation, or cared for someone in isolation, or has a suspected or confirmed case of COVID-19? *
1 point
Has the student student positive for COVID-19 within the last 10 days or have you been told to self-isolate by Public Health or a medical professional? *
1 point
If you have answered yes to any of the above questions your player SHALL NOT attend camp. Please use Ontario's Covid Self Assessment Tool and seek advice from a healthcare provider before returning to camp.
By submitting this form, the information provided in this form is, to the best of my knowledge and belief, true, accurate and complete. I am aware that a false or misleading statement/response will result in endangering the health and safety of my student, those who come in contact and the public. A knowingly false or misleading statement/response could result in legal and/or disciplinary action in the future. Please check the box below to confirm. *
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