Date you entered SindyXR

MM

DD

YYYY

Current Time

Hour

Minute

Second

AM PM

Have you had contact with anyone who has had COVID19? *

Yes

No

Has your temperature spiked recently? *

Yes

No

Have you travelled outside the tri state area in the last 14 days? *

Yes

No

CheckboxDo you promise to wash your hands while in SindyXR *

Yes

Cell in case your team needs you or for emergancies *

Country

(###)

###

####

Have you washed your hands or used alcohol-based hand sanitizer on entry? *

Yes

No

Do you have any of the following respiratory symptoms? *

New or worsening cough?

New of worsening shortness of breath?

None mentioned

Have you traveled outside tri-state area in last 14 days? *

Yes

No

Have you been exposed to anyone with COVID in the last 14 days? *

Yes

No

DISCLOSURE OF RISK AND WAIVER OF LIABILITY RELATED TO COVID-19 AND AGREEMENT:

Do you understand and agree that all parties have taken reasonable precautions to reduce the possibility of exposure of exposure to COVID-19 and that no amount of care or caution by SindyXR or TigerLabs can completely eliminate the risk of such exposure; that you will SindyXR, Inc. and Tigerlabs Management II, LLC and all parties harmless from any liabilities resulting from exposure; that you assume any risk of infection and covenant not to sue SindyXR or Tigerlabs management II, LLC or any related parties, and if you do sue, you agree to cover any legal expenses incurred by SindyXR or Tigerlabs Management II LLC or any related parties?

Yes

No