Summer Workshop Registration

 

1. What is the name of your child? *

 

2. What is their date of birth? *

   DD/MM/YYYY 
 
 

3. What is your full address? *

 

4. What borough do you live in? *

 

5. What is your Parent/Guardians full name? *

 

6. What is your email address? *

 

7. What is your telephone number? *

 

8. Please select which workshop(s) you are interested in. Choose as many as you would like.
*

 

9. Are you experiencing any of the following COVID-19 symptoms, either mild or severe? *

NoMildSevere
Fever – temperature 100.0 F or higher (please do a temperature check the morning of your visit.)
Chills
Cough
Shortness of breath
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
 

10. Have you been exposed to or in contact with anyone who has tested positive or is a presumptive positive for COVID-19 in the last 14 days? *

 

11. Have you been exposed to or in contact with anyone showing symptoms of COVID-19 in the last 14 days? *

Check out our survey templates or create your own.