WEEKLY MSTDA PRE-CLASS HEALTH SCREENING
Prior to attending class or rehearsal each week at Main Street Theatre & Dance Alliance, we ask that you complete the health screening questionnaire below. If you answer "yes" to any of the below questions or are experiencing any of the symptoms listed, please notify us and do not attend class or rehearsal.
FIRST NAME OF STUDENT or STAFF:
LAST NAME OF STUDENT or STAFF :
CLASS YOU ARE ATTENDING TODAY:
Private Music Lessons (piano, guitar, voice, violin)
Children or Teen Theatre Class/Rehearsal
Art Mentorship After-school Program
OTHER DAYS THIS WEEK YOU ATTEND CLASS - Choose all that apply:
Have you or anyone in your household tested positive for COVID-19 in the past 14 days?
Have you or any members of your family been exposed to someone who has tested positive for COVID-19 in the past 14 days?
Have you, anyone in your family, or your child experienced any of the following symptoms in the past 48 hours?
Fever over 99.9 or chills
shortness of breath or difficulty breathing
muscle or body aches
new loss of taste or smell
congestion or runny nose (not allergy related)
nausea or vomiting
None Of The Above
Send me a copy of my responses.
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