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
Student's Name: *
Parent's Name: *
Parent's Phone Number: *
Does your student or anyone living under the same household have any of the following symptoms? *
Check all that apply
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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