FFBC Reservation & Attendance Form

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Email *

Event *

Worship Service

Other

If selected 'other' please describe or specify the event

Date of Event (Date you are coming to Church) *Please note that this Sunday, March 20, 2022 is fully booked* *

YYYY

Full Name *

If attending service with people in the same household, please identify their names (For grouping and seating purposes)

Address (Street, City, Province) *

Postal Code *

Phone Number *

Check the box if you have any of the following: *

Fever or Chills?

Cough

Difficulty breathing or shortness of breath

Sore throat or trouble swallowing

Runny or stuffy nose

Decrease or loss of taste or smell

Not feeling well, extreme tiredness or sore muscles

Nausea, vomiting or diarrhea

None of the Above

Required

Have you been in close contact with someone who is sick or has confirmed COVID-19 in the past 14 days? *

Yes

Have you returned from travel outside Canada in the past 14 days? *

Yes

If you answered YES to any of these questions, we ask that you please stay home and self-isolate right away. Call Telehealth or your health care provider, to find out if you need a test.

Note: Information collected will only be used for contact tracing when needed. Forms will be destroyed 30-days after the event date lapsed.

Send me a copy of my responses.

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