Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. #MakinuInThePark - Weekend 5 (7/24-7/25/2021) Question Title * 1. Name: OK Question Title * 2. Email Address: OK Question Title * 3. Phone: OK Question Title * 4. Makinu Health & Safety Pre-Screening: Please confirm that the following statements are true for you and your household. If you cannot affirm all of the below statements, please stay home, get well and join us for one of our upcoming virtual events. I/my household have not tested positive for COVID-19 in the past 14 days. I/my household have not exhibited any of the symptoms associated with COVID-19 (i.e. fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, etc) in the past 14 days. I/my household have not knowingly been exposed to anyone who has tested positive or exhibited symptoms, such as new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, etc.) I have not traveled by plane in the past 14 days. I understand that masks and other protective gear are encouraged. I understand that social distance of 6ft/2m must be maintained at all times while attending this event. OK Question Title * 5. What is your connection to the East Palo Alto (EPA) community? (Select all that apply) I live in EPA. I work or own a business in EPA. I am from EPA. I have friends and/or relatives in EPA. I am a former resident of EPA. Other (please specify) OK Question Title * 6. Who do you wish to register for? Myself Only Myself + 1 Adult Myself + Family Other If registering for additional participants, please list as follows: Name/Age of children) and/or Name/18+ (for adults) OK Question Title * 7. What Activity Will You Participating In? Bloco Afro Brazilian Dance with Sis Regina Califa (Nzo Califa Dance) (SAT 7/24/21 @4:30-6PM) Brazilian Percussion w/Tambores Julio Remelexo (SUN 7/25/2021 @4:30-6PM) OK Question Title * 8. If registering for West African Percussion, a very limited number of drums will be available for participants to use with care. Would you like to reserve a drum to use during class? Yes, I would like to reserve/borrow a drum for class. No, I will bring my own drum to class. N/a I am just coming to observe the class. OK Question Title * 9. Are you interested in supporting future events in one or more of the following ways? Volunteering Fundraising Outreach Other (please specify) OK SUBMIT RESPONSE