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info@dancelikecpaa.org

THE CORDELION PERFORMING ARTS ACADEMY

"Where Optimism meets Opportunity"

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Registration

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Health Declaration

Please fill out the following form
in order to participate in our activity.

First Name

Last Name

Email

Date of Birth

Have you or Have you been around someone who tested positive for Covid-19in the last 10 days?

No

Yes

Are you suffering from a medical condition, illness, or injury?

No

Yes

If you answered yes to any question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

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