Attention Parents! Before each class your child attends, you must fill out our online questionnaire on this page.

Please View our Studio

Guidelines on the

"Classes & Guidelines Page"

Contact: 661-324-5678

Covid Questionnaire

Please fill out the following Covid-19 Questionnaire in order for your child to participate in Dance Class. Submissions are valid up to 24 hours prior to the activity.

Child's First Name

Child's Last Name

Email:

My body and or child's body temperature is lower than 98.6°F/ 37.5°C

Have you, your child or anyone in your household ever tested positve for Covid-19 or had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit?

Yes

Date

Initials & Phone#

I confirm that the information given in this form is true and that I do not hold PennPoint Dance and or its agents responsible for any physical injuries or illness including Covid-!9 obtain while on our company premises and or events.

Thanks for submitting!

Christmas Recital Dec 2021