Health Declaration

Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.
Are you experiencing any flu symptoms?

Thanks for submitting!

In order to meet CDC guidelines, we will need your cooperation and understanding to maintain compliance with new protocols.  Please review the following:
1) Class size will be limited with marked floor areas for students to maintain social distance - register early to ensure your spot in class!  Online is preferred via website - registration agreement must be signed as well as registration fee paid to process registration.  First month's tuition must be paid prior to first class.
2) Upon arrival, hands must be sanitized or washed, (there will be a sanitizing station available at door), temperatures will be taken with a touchless thermometer, and face coverings must be worn. 
3) Studio will be sanitized between groups of classes and surfaces will be sanitized after use.
4) The waiting area will be marked and we ask that upon arrival and departure parents maintain social distancing - it is preferred that students are left at door and picked up at door to minimize group numbers inside studio.
5) There will be a health questionnaire to evaluate any symptoms of illness prior to entrance in class, we ask that you refrain from attending class if anyone in the household is experiencing or has experienced within 14 days chills, fever, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, loss of taste/smell, sore throat, congestion, runny nose, nausea, vomiting, diarrhea, or if you have been in contact with anyone diagnosed with COVID-19.  Miss Amber must be notified IMMEDIATELY if there has been any risk of exposure.
6) Students  should bring their own water bottle to class labeled with name.   Each student should have an extra face covering in their dance bag as well as some backup sanitizer for use in between classes.  
7) Signs will be posted as reminders for parents and students.
We appreciate your assistance and cooperation during these strange times!

Health questionnaire(to be filled out by parents each class):
⦁    _____     I understand the symptoms of Covid19
⦁    _____    I affirm that neither I, nor any member in my household, currently has or has experienced the aforementioned symptoms within the past 14 days.  Furthermore, I will immediately inform Miss Amber and discontinue classes if I, or any member of my household, develops any of the aforementioned symptoms of Covid19.
⦁    _____ I affirm that neither I, nor any member in my household, has been diagnosed with Covid 19 within the past 30 days.  Furthermore, I will immediately inform Miss Amber and discontinue classes if I, or any member of my household, develops any of the aforementioned symptoms of Covid19.
⦁    _____ I affirm that neither I, nor any member in my household, has knowingly been exposed to anyone diagnosed with Covid19 within the past 30 days.  Furthermore, I will immediately inform Miss Amber and discontinue classes if I, or any member of my household, is knowingly exposed to anyone diagnosed with Covid19.
⦁    _____ I affirm that neither I, nor any member in my household, has traveled outside of the country or to any city considered a "hot spot" for Covid19 infections within the past 30 days.  Furthermore, I will immediately inform Miss Amber and discontinue classes if I, or any member of my household, returns from traveling outside the country or to any city considered a "hot spot" for Covid19 infections.
⦁    ____ I understand that AHA! Dance LLC cannot be held liable for any exposure to Covid19 caused by any misinformation on this form or the health history provided by each student.  
Student Name:                                                                                                     Date:
Class:                                   Signature:______________________________________