COVID Self Declaration Form

COVID-19 Declaration Form

Signature Required Prior to Resuming Dance Classes
Which class is your child attending

Monday MinisMonday Junior 1Wednesday Junior 2Wednesday Junior 3Wednesday Inter 1Friday Inter 2Friday Inter 3Junior Competition ClassInter Competition ClassSenior Competition ClassOther
Child’s Name

First nameSurname
COVID-19 Common Symptoms, as per WHO:
- Fever
- Dry Cough
- Tiredness
I agree to the following:

I understand the aforementioned COVID-19 symptoms.I can confirm that neither I, nor any member of my household, currently has or has experienced the COVID-19 symptoms within the past 14 days.I can confirm that neither I, nor any member of my household, has been diagnosed with COVID-19 within the past 30 days.I can confirm that neither I, nor any member of my household, has knowingly been exposed to anyone diagnosed with COVID-19 within the past 14 days .I can confirm that neither I, nor any member of my household, has travelled abroad within the last 14 daysI can confirm that the above named student has not been requested by a doctor to currently self isolateI will notify LCDA if I am unwell and displaying symptoms of COVID-19
LCDA will be adhering to the following procedures to prevent the spread of COVID-19.

Our teachers and volunteers will…
- Clean/Disinfect frequently touched surfaces thoroughly and at regular intervals.
- Wash/Sanitize our hands before and after each session.
- Wear our masks when necessary - ie when assisting the children in and out of the building.
- Maintain a safe distance at all times.
- Accommodate a limited number of students in each class to ensure we are Social Dis-dancing! Dancers will be grouped into pods of no more than 6.
- Schedule classes so as to allow time for cleaning/disinfecting surfaces and allow students to finish and leave the studio before the next set of students arrive.
- Provide sanitizers in the reception area and other locations within the premises.
We are requesting that each of our students, please....
- Maintain a safe distance from others at all times.
- Arrive 5 mins before their allocated class time
- Use the hand sanitizer before entering and while exiting the studio.
- Carry their own bottle or cup for drinking water.
- Arrive to class in their Dancewear and leave unnecessary items at home.
- Enter the building by themselves. Lisa will meet all dancers at the front door and will also escort the children back to parents at the front of the building after class - especially the younger students. NO PARENTS WILL BE PERMITTED IN THE BUILDING. We also ask that you don't congregate in groups whilst dropping off or collecting your child.
By signing below, I agree to each statement above in order to protect the health and safety of our students.
Parent or Guardian's Name in Full

First nameSurname
Mobile Number

Country CodePhone Number
Email Address
example@example.com
Signature

Clear
Please sign above
Date

DayMonthYear
Date of Submission
Should be Empty:

COVID-19 Declaration Form