Emerge Dance Academy's COVID-19 Mandatory Before Class Checklist
Name *
Today's Date *
MM
/
DD
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YYYY
Do you have any of the following symptoms: *
Yes
No
Fever (Higher than 38.0 C)
Cough
Shortness of Breath / Difficulty Breathing
Sore Throat
Runny Nose
Have you or anyone in your household travelled outside of Canada in the last 14 days? *
Have you or anyone in your household been in contact with anyone being investigated OR with a confirmed case of COVID-19 in the last 14 days? *
Are you currently being tested for a possible case of COVID-19? *
Have you tested positive for COVID-19 within in the last 14 days? *
I understand and agree that even with social distancing and sanitization protocols, there is a possibility of contracting the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus which can lead to the COVID-19 (coronavirus disease) while attending Emerge Dance Academy. I voluntarily agree, therefore, to assume all risks and responsibility of contracting the SARS-CoV-2 virus, which I could contract during any of Emerge Dance Academy inc classes. I also exempt and release, Emerge Dance Academy Inc and its owners, employees, assistants, volunteers, guest artists, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me or property which may arise out of or in connection with SARS-CoV-2 and COVID-19 . I understand it is especially important to alert Emerge Dance Academy y Inc of any health conditions I may have that are similar symptoms of SARS-CoV-2 and/or COVID-19. These health conditions and symptoms include but are not limited to a cough and/or shortness of breath due to asthma or exercise induced asthma, and/or a sore throat, runny nose and/or nasal congestion due to severe seasonal allergies. *
Required
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