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HEALTH QUESTIONAIRE

By signing this questionnaire, I acknowledge that I will, to the best of my ability, comply with the health standards expected at Alaska Dance Promotions.

I understand that dance and any physical and social activity has risks. These risks include, but are not limited, to injury & illness.

I will not hold Alaska Dance Promotions, the owners, affiliates, employees, volunteers or other dancers & customers liable for my participation. 

I will not attend any classes or lessons at Alaska Dance Promotions if any of my answers in this questionnaire are "YES".

It is recommended that people who are "high risk" for illness or injury do NOT attend dance group classes and to consult your doctor regarding your personal risk category.

First Dancer Name

First Name*

Last Name*
First Dancer Age Acknowledgment*
First Dancer Date of Birth*
I certify that I am 18 years of age or older
First Dancer Signature*
Second Dancer Name

First Name*

Last Name*
Second Dancer Date of Birth*
Third Dancer Name

First Name*

Last Name*
Third Dancer Date of Birth*
Fourth Dancer Name

First Name*

Last Name*
Fourth Dancer Date of Birth*
Fifth Dancer Name

First Name*

Last Name*
Fifth Dancer Date of Birth*
Sixth Dancer Name

First Name*

Last Name*
Sixth Dancer Date of Birth*
Seventh Dancer Name

First Name*

Last Name*
Seventh Dancer Date of Birth*
Eighth Dancer Name

First Name*

Last Name*
Eighth Dancer Date of Birth*
Ninth Dancer Name

First Name*

Last Name*
Ninth Dancer Date of Birth*
Tenth Dancer Name

First Name*

Last Name*
Tenth Dancer Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Health Questionnaire
Have you had a positive COVID-19 test result in the last 7 to 10 days?*
No
Yes
Are you currently experiencing a fever over 100 degrees Fahrenheit, difficulty breathing, or cough related to sickness?*
No
Yes
Have you traveled out of the country for travel other than work, within the last 10 days, without a negative Covid test?*
No
Yes
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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