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Please complete this form prior to coming to each workout
*
Indicates required field
Name
*
First
Last
Cell Phone Number
*
Today's Date
*
HAVE YOU (PARTICIPANT) BEEN ILL WITH A FEVER, CHILLS, COUGH OR BODY ACHES IN THE LAST 14 DAYS?
*
Yes
NO
HAS ANYONE IN YOUR HOUSEHOLD HAD THESE SYMPTOMS IN THE LAST 14 DAYS?
*
Yes
No
HAVE YOU OR ANYONE IN YOUR HOUSEHOLD TRAVELED INTERNATIONALLY IN THE LAST 14 DAYS?
*
Yes
No
HAVE YOU (PARTICIPANT) OR ANYONE IN YOUR HOUSEHOLD TRAVELED TO A LOCATION IN THE US WHERE AN INCREASE OF INCIDENCES OF COVID-19 HAS BEEN REPORTED IN THE LAST 14 DAYS?
*
Yes
No
HAVE YOU (PARTICIPANT) BEEN TOLD BY A HEALTHCARE PROVIDER THAT YOU SHOULD SELF-QUARANTINE DUE TO POTENTIAL COVID-19 EXPOSURE OR YOU ARE SUSPECTED OF HAVING COVID-19?
*
Yes
No
BY CHECKING THE BOX BELOW, YOU AGREE THAT YOUR STATEMENTS ARE ALL TRUE TO THE BEST OF YOUR KNOWLEDGE
*
I AGREE
Submit
Classes
schedule
descriptions
Programs
Personal Training
Performance Training
Fitness
Massage
Seniors
adult art
Events
Sports
Kids
KidSpace
Parties
COVIDWAIVER