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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/Caregiver is entering... You must fill out another form with parent/Caregiver 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!
If a child/student is not fully vaccinated but is exempt from federal quarantine because they travelled with a fully vaccinated companion, they must not go to school/child care for 14 days. Select “Yes” if this applies.
Anyone who is sick or has any symptoms of illness, including those not listed below, should stay home until their symptoms are improving for 24 hours and seek assessment from their health care provider if needed.
Select “No” if the person has not tested positive for COVID-19 and only has one of these symptoms: sore throat or difficulty swallowing, runny or stuffy/congested nose, headache, extreme tiredness, muscle aches or joint pain, nausea, vomiting and/or diarrhea.
If you already went for a test and got a negative result, select "No."
If public health guidance provided to you has advised you that you do not need to self-isolate, select “No.”
Parent/Caregiver Name *Dancers Name if over 18 Years of age.