Audience Health Screening
Sandy Stramonine School of Dance
2021 Recitals
Sunday June 27, 2021
 
In order to attend any of our shows on Sunday June 27, 2021, you MUST answer the following questions truthfully, sign/date at the bottom of this form, and hand it in as you enter the school.
*All audience members must wear appropriate face coverings
 
1) What show are you attending?  Please Circle:         Show 1            Show 2            Show 3

2) Do you have a temperature  higher than or equal to 100.4 degrees Fahrenheit?  
 Circle:              Yes      or         No

3) Have you had any known contact with a person confirmed to or suspected to have COVID-19 in the past 14 Days and is designated as a close contact by the Department of Health?  
 Circle:              Yes      or         No

4) Are you currently experiencing  ANY COVID-19 related symptoms including but not limited to loss of taste/smell, cough, shortness of breath, sore throat, etc.?  
Circle:   Yes or No

5) Have you tested positive for COVID-19 through a diagnostic test in the past 14 days?  
 Circle:              Yes      or         No 

6) Are you currently under quarantine by the Department of Health and unable to attend school or work? 
Circle:              Yes      or         No
 
Print Name:  __________________________________    
 
Signature:  ___________________________________                 Date:  ___________________
 
**If you have answered 'Yes’ to ANY of these questions, You will NOT be allowed to enter the theatre. This is to keep our audience, dancers, volunteers, and staff safe.