Health Declaration Form

COVID-19 Health Declaration

Red Shoe Dance Company is committed to providing a safe environment for our students and staff members. Please complete this form prior to your child attending class. This declaration form is mandatory and must be signed by the parent for each individual child attending the studio

COVID-19 Health Declaration Form

* Indicates required field

Student Name (If more than one child attending classes, please fill out a separate form) *

First

Last

Parent Name *

Email *

Please check each box to confirm all the statements below are true *

My child and other family members have not had any of the following symptoms in the past 14 days – fever, malaise, dry cough, shortness of breath or other flu-like symptoms. My child and other family members have not travelled outside of Hong Kong within the last 14 days My child and other family members have not been in close contact with anyone in the past 14 days who has tested positive for COVID-19 My child and other family members have not been in close contact with anyone who has been outside of Hong Kong in the past 14 days. Close contact generally means: having direct physical contact, living in the same household, travelling in the same vehicle or flight, having social contact in close proximity such as dining together, sleepovers, playdates etc. My child has been fully vaccinated with 2nd injection given within the last 14 days. I confirm that the above information and declaration is accurate to the best of my knowledge and agree that such information will be processed and used in accordance with the Red Shoe Dance Company’s Privacy Policy. I understand that making a false declaration may jeopardise the health and safety of students and staff members as well as the continuation of opening the school. I acknowledge that knowingly making a false declaration and/or a failure to abide by these regulations will result in the student being asked to leave the school indefinitely.

If you are unable to check any of the boxes above, please state your reasons below *

Submit