COVID-19 Courtesy Screening
For the protection and health considerations of you and our church family,  please fill out this form prior to entering St Alexis Church. (One form may be filled out per household)
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이메일 *
1. Are you (or a member of your household) currently experiencing, or have you experienced in the past 14 days, any of the following symptoms? Check all that apply.
NAME   (One form may be filled out per household visiting today)
2. In the past 14 days, have you (or a member of your household) been in close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since your contact?
3.  In the past 14 days, have you (or a member of your household) been in close proximity to anyone who has tested positive for COVID-19?
선택해제
4. Have you (or a member of your household) been tested for COVID-19 and are waiting to receive test results?
선택해제
5.  Have you (or a member of your household) have tested positive for COVID-19, or are you presumptively positive for COVID-19 based on your health care provider’s assessment or your symptoms?
선택해제
6. In the past 14 days, have you (or a member of your household) been on a commercial flight or traveled outside of Connecticut?
선택해제
7.  In the past 14 days, have you (or a member of your household) been in close proximity to anyone who has been on a commercial flight or traveled outside of Connecticut?
선택해제
Note:
In the interest of the health and safety of our parish community, if you have any current symptoms or you’ve answered yes to any of these questions we ask that you attend our service via our streaming channel at www.facebook.com/stalexischurch or via Zoom (may request an invitation from Fr Steven).
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St Alexis Orthodox Church
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