WEEKLY WELLNESS CERTIFICATION

At Collective Energy Yoga Studio we are committed to providing a safe environment for our students and providers. We also need your help to keep this a safe environment. This includes having all who are utilizing our studios to complete the survey below. Student guardians please fill out for student, sign and date below.
Do you currently have any signs or symptoms of COVID-19? (fever, cough, shortness of breath?)
Have you had any of these symptoms in the last two weeks?
Are you prestently caring or living with someone who has experienced the signs or symptoms of COVID-19 in the last two weeks?
In the last two weeks have you been, or has someone that you lived with been under quarantine for COVID-19?
In the last two weeks has your temperature exceeded 99.5 degrees?
In the last two weeks have you tested positive for COVID-19?

Please execute this form and submit below. If you answered yes to any of these questions above, you must proceed home and return when at least two weeks from symptoms have passed.

Parent/Guardian Signature

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