COVID-19 Screening Questionnaire

Jul 13, 2020 by

In an effort to simplify the daily COVID-19 screening (and save trees in the process!), the questionnaire is now available online. Please complete and submit for yourself (faculty and students) or your dancer (parents and legal guardians). Thank you for keeping yourselves and our dance community safe and healthy!

 

COVID-19 Screening Questionnaire

COVID-19 Screening Questionnaire

Faculty, dancers, and legal guardians: please complete the following screening questionnaire before coming to the studio for your classes.

Your name (faculty and students) or the name of the dancer (parents and legal guardians).
mm/dd/yyyy
Have you been tested for COVID-19 or had a positive test result for COVID-19 in the previous 14 days? *
Have you been exposed to someone with a pending or positive test result for COVID-19 in the previous 14 days? *
Have you recently experienced two or more of the following: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell? *
Do you have a persistent cough or shortness of breath? *
Have you traveled outside of your normal routine in the previous 14 days?
Do you have a fever of more than 100.4 degrees? *

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