Please fill out and submit the form below to sign up for the April Practicum with Deanna at The Estonian House from 7:30pm-11:00pm on Saturday 4/24

Due to Covid regulations attendance will limited so please sign up in advance.

Name

First Name

Last Name

Email Address

I understand I am to abide by social distancing guidelines outlined by the NYS Department of Health

I understand I will maintain 6 foot distance during class

Covid-19 Liability Waiver

The CDC Describes Covid-19 Symptoms as: fever or chills, cough, shortness of breath, or difficulty breathing, fatigue, body aches, head aches, sore throat, congestion or runny nose, vomiting or diarrhea. The list does not include all possible symptoms. Please visit CDC.gov for the most up to date symptom list. Please Read and Initial the following: 1. I understand the above symptoms. 2. I affirm that I, as well as all of my household members do not currently have the above symptoms or experienced the above symptoms in the last 14 days. 3. I affirm that I, as well as all of my household members have not been diagnosed with Covid-19 in the last 30 days. 4. I affirm that I, as well as all of my household members have not knowingly exposed to anyone diagnosed with Covid-19 in the last 30 days. 5. I affirm that I, as well as all of my household members have not traveled outside the country or any city considered to be a “Hot Spot” for Covid-19 within the past 30 days. 6. I affirm that if I, or any of my household members develop symptoms consistent with Covid-19, I will not attend class. 7. I understand that Dancing With Deanna, its owners, representatives or employees cannot be held liable to any exposure to the Covid-19 virus as a result of participate in classes, studio events or activities.

Dancing With Deanna

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Member of NTA (National Teachers Association) with current ASCAP, BMI and SESAC licenses. Also a member of LICMA (Long Island Country Music Association), approved by ESBOCES Arts In Education (AIE) Program