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* 1. Phone or Email (Talent, Agent or Manager)

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* 2. Full Name

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* 3. Date Expected to arrive at the facility

Date

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* 4. Have you traveled outside of your state within the last 14 days?

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* 5. Have you or someone you care for been diagnosed with COVID-19?

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* 6. Have you had close contact (defined as within 6 feet for 10 minutes cumulatively within 24 hours) with someone diagnosed with Covid-19 within the last 14 days?

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* 7. Have you been in close contact with anyone who has traveled outside of the country within the last 14 days?

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* 8. Have you or someone that you live with experienced any cold or flu-like symptoms in the last 14 days( fever, chills, cough, shortness of breath, difficulty of breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose nausea or vomitingm diarrhea)?

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* 9. Are you currently under isolation or quarantine orders?

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* 10. Please check and confirm the above answers before submitting. By confirming you agree you have been truthful in answering the questions in this questionnaire. If you answered "yes" to any of the questions above, we may not be able to grant access to the facility for at least 14 days.

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