请来教会前仔细阅读并填写 Please read and answer the questions below carefully before entering the church building
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姓名（Name） *
邮件（Email）如果之前已经填过，请填XX. (Put XX if you already entered your email before) *
电话（Phone）如果之前已经填过，请填XX. (Put XX if you already entered your phone number before) *
我确认我以及所有家庭成员目前在过去48小时内没有任何以下症状或者Covid检测为阴性：1. 发烧(>100F {37.8C} 或感觉发烧/发冷 2. 呼吸急促 3.喉咙痛 4.咳嗽 5.鼻塞/流鼻水 6.生病带来的肌肉痛 7.味觉丧失 （I affirm that I, as well as all household members do not currently have any of the following symptoms within the past 48 hours or my Covid test is negative: 1. Fever (>100F {37.8C} or feeling feverish/chills 2. Shortness of breath 3. Sore throat 4. Cough 5. Nasal congestion/runny nose 6. Muscle aches 7. Loss of smell of taste） *
Required
我确认我和所有家庭成员都没有根据MA政府/CDC指南或健康专业人士的建议进行隔离（I affirm that I, as well as all household members, are not in quarantine based on the MA government/CDC guideline or the recommendation of a health professional.） *
Required
我确认我和所有家庭成员在过去14天内没有被诊断出患有COVID-19, 或者我们有医疗专业人员出具的的公开聚会许可。（I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 14 days, or if so, we have obtained a clearance for public gathering from a medical professional.） *
Required
如果我或者家庭成员刚从国外回来，我确认已经做过Covid-19检测为阴性并且在家隔离超过7天。（If I or my household members arrived from a foreign country, I affirm that I tested negative for Covid-19 and have self-quarantined at home for a full 7 days. )
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通过提交上述表格，我证明我以上填写都属实，并免除安城华人基督教会因无意暴露COVID-19 或照成的伤害而承担任何和所有责任。 （By submitting the form, I attest that each of my answers above are true.  I also affirm and release Amherst Chinese Christian Church from any and all liability for unintentional exposure or harm due to COVID-19. ） *
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