Dancing Soma COVID-19 Health Screening Questionnaire

In order to make our studio and your child’s dance experience as safe as possible given the concerns with COVID-19, we ask that this screening form is filled out and submitted prior to arriving at the studio each day for all staffs and students.  If you have multiple family members dancing with us on a single day, please fill out this form once of each dancer.

* Please fill in required fields

Personal Contact Info

 

Please answer the questions

 
 
 
 
 
If the answer to symptoms above is Yes/Tick.  Entrance into program/class can not be permitted if any of the symptoms are visible or occurring under the  COVID-19 restrictions but must still be noted here for possible use in contact tracing by medical authorities.