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COVID SYMPTOMS SURVEY - COASTAL DANCE FESTIVAL
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Indicates required field
Students Name
*
First
Last
Email
*
Do You Currently have any of the following symptoms: Choose Any
*
Fever
Cough
Cold Symptoms
Body Aches
Loss of Taste or Smell
Unexplained Heachache
Unexplained Fatigue
General Feeling of Being Unwell
Vomiting or Diarrhea
Sore Throat
NON OF THE ABOVE
In the last 14 days, have you been in contact with someone who has tested positive for COVID 19 or displayed symptoms listed above
*
YES
NO
In the last 14 days, have you or anyone in your household returned from travelling out of country or the east coast of Canada
*
YES
NO
This Survey Was Completed By:
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