Please fill out this form and submit by 1pm on the DAY OF YOUR CHILD'S CLASS for your dancer to be able to participate in class.

* Required fields
Name *
E-mail Address *
DATE *
Student's Name *
All symptoms below must be checked in order to enter the building and take class at TTP......MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

COUGH
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

SHORTNESS of BREATH or DIFFICULTY
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

FEVER or CHILLS
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

REPEATED SHAKING with CHILLS
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

MUSCLE or BODY ACHES
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

HEADACHE
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

SORE THROAT
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

LOSS OF TASTE or SMELL
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

NAUSEA or VOMITING
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

DIARRHEA
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

RUNNING or STUFFY NOSE
MY CHILD HAS NOT HAD THE FOLLOWING SYMPTOM IN THE LAST 24 HOURS: *

FATIGUE
Parent/Guardian's Signature. Please type in your name and date below: *
I have read and agree to the Privacy Policy *

3 LOCATIONS:

999 Oaklawn Ave. Cranston R.I. 942-5554 9 Cedar Swamp Rd. Smithfield R.I. 354-0054 2435 Nooseneck Hill Rd. Coventry R.I. 385-9500