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CYT Covid-19 Rehearsal Health Questionnaire

If you answer yes to any of the following questions, please remain online and attend rehearsals virtually. Our main priority is to keep all students and teachers safe, so when in doubt please stay home.

Student Name

Student 2 Name (if applicable)

In the last 48 hours, have you/your child(ren) experienced any of the following symptoms? (not related to allergies or know medical issues)

Temperature above 100.4 degrees Fahrenheit

Sore throat

Uncontrolled cough that causes difficulty breathing

Diarrhea, vomiting, or abdominal pain

New onset of severe headache, especially with fever

Shortness of breath

Muscle aches

Loss of taste or smell

None of the above

In the last 14 days, has anyone in your household had close contact with someone who is confirmed to have Covid-19?

Yes

No

Are you currently isolating or quarantining because you may have been exposed?

Yes

No

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

ABOUT US >

Our vision is to provide high quality theatrical experiences and outreach programs in performing arts for the youth of the Central Coast.

CONTACT >

T: 805-825-2455

P.O. Box 2425

Pismo Beach, CA 93448

United States

© 2021 by Coastal Performing Arts Foundation.