Covid-19 Health Form

Please fill out our questionnaire and show to our box office or house management personnel in order to be admitted to the event. 

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* 1. Full Name

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* 2. Within the last 10 days have you been diagnosed with COVID-19 or had a test confirming you have the virus?

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* 3. In the past 14 days, have you had “Close Contact”* with someone who was diagnosed with COVID-19 or had a test confirming they have the virus while they were contagious**

*“Close Contact” means you had any of the following types of contact with the person with COVID-19 while they were contagious**

• Lived or stayed overnight with them
• Was their intimate sex partner
• Took care of them or they took care of you
• Stayed within 6 feet of them for more than 15 minutes
• Exposed to direct contact with their body fluids or secretions (e.g., they coughed or sneezed on you) while you were not wearing a face mask, gown, and gloves

**Contagiousness: People with COVID-19 are considered contagious starting 48 hours before their symptoms began until 1) they haven’t had a fever for at least 24 hours, 2) their symptoms have improved, AND 3) at least 10 days have passed since their symptoms began. If the person with COVID-19 never had symptoms, then they are considered contagious starting 48 hours before their test that confirmed they have COVID-19 until 10 days after the date of that test.

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* 4. Have you had one or more of these symptoms today or within the past 24 hours which is new or not explained by another condition?

• Fever (100.4F/38.0C or greater), chills, repeated shaking/shivering
• Cough
• Sore throat
• Shortness of breath, difficulty breathing
• Feeling unusually weak or fatigued
• Loss of taste or smell
• Muscle or body aches
• Headache
• Runny or congested nose
• Diarrhea
• Nausea or vomiting

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