Please complete the following questions before beginning your class today.

*If you are a parent coming to participate in dance class, Please fill out a separate form for yourself as well!

*If a parent/Guardian is entering... You must fill out another form with parent/Guardian name as well

Are you currently experiencing any of these symptoms? Answer YES or NO to each Sympton.

This includes getting a COVID Alert exposure notification. Close physical contact means: being less than 2 metres away in the same room, workspace, or area living in the same home being in the same classroom

If you answered YES to any of these questions, go home & self-isolate right away.

Visit hamiltion.ca/coronavirus for more information as you may be eligible for a COVID-19 test.

If feeling unwell, contact your health care provider or call Telehealth Ontario at 1-866-797-0000 to speak to a registered nurse.

If you answered NO to all of these questions, you can go attend your activity.

Parent/Guardian Name *Dancers Name if over 18 Years of age.