Music Video Extra COVID-19 Health Declaration
Full Name
Email Address
Phone Number
Date
Health Screening
Fever
Cough
Shortness of breath
Loss of taste or smell
None of the above
Exposure History
Close contact with a confirmed COVID-19 case in the past 14 days
Traveled internationally in the past 14 days
None of the above
I declare that the above information is accurate and complete. I understand that providing false information may affect my ability to participate in the production.
Signature