COVID-19 Contact Tracing
To help prevent the spread of COVID-19 and to reduce the potential risk of exposure to or students and staff, we are conducting a simple, weekly screening questionnaire. Please take a moment to answer all questions and submit the form before your child's first class each week.
All Vision students must submit the form 24-hours before attending the first class of the week
Parent's Phone Number:
Does your student or anyone living under the same household have any of the following symptoms?
Check all that apply
New or increased shortness of breath
Decreased sense of smell or taste
Sore or scratchy throat
Muscle aches and pains
None of the above
Has your student or anyone living under the same household been in close contact with someone who tested positive for CO-VID19 in the last two weeks?
I understand that if I am a high risk student and I choose to continue to take class at Vision, I am choosing to do so at my own risk and release Vision Dance & Learning Center of any liability or responsibility.
Parents or Guardians: I certify that I have answered the questions above truthfully and to the best of my availability (Please type your legal name in the box below. This will count as your signature).
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