Covid Screener | Yoga High | New Windsor, New York

Yoga High COVID-19 Screening

All visitors must fill out this form prior to entering the studio. Thank you for cooperation.

First Name

Last Name

I have knowingly NOT been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19

I have NOT tested postive for COVID-19 in the last 14 days

I have NOT traveled outside of NYS to an area with high prevalence of COVID-19 in the past 14 days? (**If so, it is required that you follow NYS' travel advisory regulations)

Symptoms of Coronavirus

THE TERM “SYMPTOMATIC” INCLUDES ANYONE WHO HAS THE FOLLOWING SYMPTOMS OR COMBINATIONS OF SYMPTOMS:
Fever
Cough
Shortness Of Breath

OR AT LEAST TWO OF THE FOLLOWING SYMPTOMS:
Fever
Chills
Repeated Shaking With Chills
Muscle Pain
Headache
Sore Throat
New Loss Of Taste Or Smell

I do NOT have any of the symptoms listed above.

My body temperature is lower than 99.5°F

Initials

Date

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

Thanks for submitting!

Yoga High COVID-19 Screening

YOGA HIGH

287 WINDSOR HWY #400, NEW WINDSOR, NY

302 Main St, Highland Falls, NY