Please complete the following questions before beginning your class today.

*If you are a parent/Adult coming to participate in dance class or coming into the Facility, Please fill out a separate form for yourself as well!

You must choose one of the above.
*If a parent/Guardian is entering... You must fill out another form with parent/Guardian name as well
This information is for Contact Tracing. Thank you!
This information is for Contact Tracing. Thank you!
This information is for Contact Tracing. Thank you!
This can be because of an outbreak or contact tracing.
If public health has advised you that you do not need to self-isolate, select “No.”
If you already went for a test and got a negative result, select "No."
If the person got a COVID-19 vaccine in the last 48 hours and is experiencing a mild headache, fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.”
If you have since tested negative on a lab-based PCR test, select "No."
If you answered YES to any of these questions, go home & self-isolate. Call Telehealth or your health care provider to find out if you need a test. If you answered NO to all of these questions, you can attend your activity. The above questions are used to screen for COVID-19 before entry, as per direction from the Medical Officer of Health.
Parent/Guardian Name *Dancers Name if over 18 Years of age.