COVID-19 PRE-SCREENING
Must be completed by all dancers & staff upon arrival, before entry into Thrive Outside
Dancer
*
First Name
Last Name
Parent/Dancer Email (parent - if dancer is under 18)
*
example@example.com
Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions. (Only check off if symptoms are present)
Fever
Difficulty breathing
New or worsening cough
Sore throat or trouble swallowing
Runny or stuffy nose / nasal congestion
Decrease or loss of sense of taste or smell
Nausea, vomiting, diarrhea or abdominal pain
Not feeling well, extreme fatigue or tiredness, body aches
*
YES
NO
Have you travelled outside of Canada in the last 14 days?
*
YES
NO
Have you come into close contact with a confirmed or probable, positive case of COVID-19?
*
YES
NO
Submit
Should be Empty: