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Full name (of dancer, staff or person entering The Dance Zone:
Participant's Temperature Today (indicate C or F):
Have you experienced any of the following symptoms in the last 24 hours ?:
Fever (temperature of 37.8 C / 100.4 F or greater)
New or worsening cough
Runny nose or nasal congestion (unrelated to seasonal allergies, post nasal drip, etc)
Shortness of breath/Difficulty breathing
Sore throat or difficulty swallowing
New smell or taste disorders
Nausea/Vomiting, Diarrhea/Abdominal pain
Unexplained fatigue/malaise/muscle aches
Pink eye (conjunctivitis)
Red/purple discolouration to hands, fingers, feet and/or toes and skin may peel
Worsening of chronic conditions
None of the above
Have you had close contact with anyone with acute respiratory Illness or travelled outside of Ontario in the past 14 days?:
Have you or anyone in your household tested positive for COVID-19 in the last 14 days?:
Have you or anyone in your household recently been tested for COVID-19 and are awaiting results?:
Have you or anyone in your household had close contact with anyone with a confirmed or probable diagnosis of COVID-19 or who is being tested for COVID-19 within the past 14 days?:
A copy of your responses will be emailed to the address you provided.
Please tick to verify that you are not a robot
Our Clients Say
Thank you to all the wonderful and caring teach...
Best Dance Studio in Vaughan for 12th year in a Row!
Mar 19 2021
Thank you to everyone who voted for us...The Reader's Choice Winner for the Best Dance Stud...
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Address: 8520 Jane Street, unit #3, Concord, Ontario, Canada, L4K 5A9
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