Pre-UV Performing Arts Dance Class Attendance Questionnaire
Thank you for your continued trust in UV Performing Arts. We kindly ask all students to review the following questionnaire ahead of your next class attendance:
*Required
Student Name *
1, Have you, your child, or others accompanying you to the next dance class traveled internationally in the past 14 days? *
*If "Yes", please tell us the date of your entry to United State.
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2, Have you, your child, or others accompanying you to the next dance class or other recent acquaintances tested positive for or been diagnosed as having COVID-19 or any other communicable disease? *
3, Do you, your child, or others accompanying to today's lesson or other recent acquaintances have a Fever (defined as above 99.6 degrees)? *
4, Do you , your child, or others accompanying you to today's lesson or other recent acquaintances have a cough? *
5, Do you , your child, or others accompanying you to today's lesson or other recent acquaintances have shortness of breath and/or trouble breathing? *
6, Do you , your child, or others accompanying you to today's lesson or other recent acquaintances have persistent pain, pressure, or tightness in the chest? *
Are you able to provide your own mask, drinking water and hand sanitizer? *
Responsible Party Full Name *
Best Telephone Number to Reach You *
By clicking submit I acknowledge that I've answered truthfully and consent to in-studio lessons.
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