Chelsea's Dance Pac COVID-19 Assessment
The Health and Safety of our staff and dancers is our top priority. This form is to be completed by all staff and dancers prior to entering the facility and participating in any activity each day before their dance class.
Parents/Guardians are required to complete the assessment each day their dancer will be at the studio as well as one form per dancer.
Participants must not attend if they are showing any signs or symptoms of COVID-19, have been in contact with a known case of COVID-19, or if you've selected 'yes' to any of the questions.
We thank you for your continued support in stopping the spread of COVID-19 and keeping our community safe!
Dancer's Name (First and Last)
In the past 72 hours, have you experienced any of the following symptoms*? *symptoms: the above noted symptoms are generally defined as new to the individual and unexplained *
Fever or Chills
Difficulty breathing or shortness of breath
Loss or change to sense of smell or taste
Sore throat or unexplained runny nose
Stuffed nose/nasal congestion
Nausea, vomiting, diarrhea, abdominal pain
Feeling unwell, extreme tiredness, sore muscles
I have not experienced any of the above symptoms
In the past 14 days have you been in close contact with a confirmed or presumed case of COVID-19?
In the past 14 days, have you recently travelled outside of Canada?
A copy of your responses will be emailed to the address you provided.
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