By submitting this form, I certify the following:

• I am not experiencing any symptoms such as fever (100.0 and above) or chills, cough, shortness of breath, sore throat, fatigue, headache, muscle/body aches, runny nose/congestion, new loss of taste or smell, or nausea, vomiting or diarrhea.
• I have not had “close contact” with an individual diagnosed with COVID-19. “Close contact” means living in the same household as a person who has tested positive for COVID-19, caring for a person who has tested positive for COVID-19, being within 6 feet of a person who has tested positive for COVID-19, or coming in direct contact with secretions (e.g., sharing utensils, being coughed on) from a person who has tested positive for COVID-19, while that person was symptomatic.
• I have not been asked to self-isolate or quarantine by their doctor or a local public health official.

If any of the above changes or is inaccurate as of the time of visit, I understand that I should NOT come to the studio until such time that I can certify all of the above. I understand that these procedures are in place pursuant to state guidelines designed to protect me and others and to help reduce the risk and spread of COVID-19.