COVID-19 Policy Acknowledgement & Health Attestation (required for facility entry)

FCTV remains committed to providing a safe and welcoming environment. Faciitating video production work during COVID-19 necessitates that we institute protocols including requiring anyone entering to sign our COVID-19 Policy Acknowledgement & Health Attestation form before being allowed entry to the Falmouth Community Media Center. This form must be submitted a minimum of two but no more than 24 hours prior to entry.

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Please indicate your level of COVID-19 vaccination.
(Fully vaccinated occurs two weeks after receiving the second dose of the two-dose vaccine (Moderna or Pfizer) or two weeks after the single-dose (J & J) vaccine.)

Please sign your name and initials and date the form below.