COVID-19 Screen
Balance COVID-19 Class Screening Questionnaire
Please complete prior to attending class.
Name *
Email *
Have you experienced any of these symptoms in the past 10 days (not related to chronic, known conditions or seasonal allergies): *
Have you traveled outside of New York State in the past 14 days? *Please note, if you have traveled to any state on the NYS travel advisory list, please wait the required 14 days before returning to class for your safety and ours. *
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