COVID-19 Questionnaire

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To ensure the safety of our clients, participants, and staff, please complete the form below before entering the studio.

Name
First Last
Email Address*
Phone*
Do you have a fever or chills?*
- Yes
- No
Do you have a cough or barking cough?*
- Yes
- No
Do you have difficulty breathing?*
- Yes
- No
Do you have a sore throat or difficulty swallowing?*
- Yes
- No
Do you have a decrease or loss of taste or smell?*
- Yes
- No
Do you have nausea as well as vomiting or diarrhea?*
- Yes
- No
Are you feeling unwell?*
- Yes
- No
Have you or anyone in your household travelled outside of the country in the last 14 days and were asked to quarantine?*
- Yes
- No
Has anyone in your household tested positive for Covid-19 in the past 14 days?*
- Yes
- No
YOU ANSWERED NO TO ONE OF THE QUESTIONS ABOVE. PLEASE DO NOT ENTER AND CONTACT THE STUDIO

Creating a generation of artists who have no fear in enhancing their skills and exploring their creativity!
-Revival Dance Company

YOU ANSWERED NO TO ONE OF THE QUESTIONS ABOVE. PLEASE DO NOT ENTER AND CONTACT THE STUDIO